SOl^ 


NEW-WORLD    SCIENCE    SERIES 
Edited  by  John   W.  Ritchie 

PERSONAL  HYGIENE 
AND  HOME  NURSING 

A  Practical  Text  for 
Girls  and  Women  for 
Home  and  School  Use 

by 
Louisa  C.  Lipfitf,  R.N. 

Assistant  Professor  of  Corrective  Exercises,  University  of  Wisconsin 
A  Head  Reconstruction  Aide  in  Physiotherapy,  Medical  Department 

United  States  Army 
Formerly  Instructor^  National  School  of 

Domestic  Arts  and  Sciences 

and  Instructor  in  the  Training  Schools 

of  Garfield  Memorial,  Providence,  Columbia 

and  Other  Hospitals 

T 

ILLUSTRATED 


Yonkers-on-Hudson,  New  York 

WORLD   BOOK   COMPANY 

1920 


WORLD    BOOK    COMPANY 

THE    HOUSE    OF    APPLIED    KNOWLEDGE 

Established,  1905,  by  Caspar  W.  Hodgson 
YONKERS-ON-HUDSON,  NEW  YORK 
2126    PRAIRIE   AVENUE,   CHICAGO 

The  aim  of  the  World  Book  Company  is  to 
publish  practical  texts,  "books  that  apply 
the  world's  knowledge  to  the  world's  needs." 
It  gives  the  editor  and  publisher  unusual 
pleasure,  therefore,  to  be  able  to  issue  at 
this  time  of  great  scarcity  of  physicians  and 
nurses,  a  volume  of  such  immediate  help  as 
Lippitt's  Personal  Hygiene  and  Home  Niirsing. 
The  author  is  at  present  with  the  colors  in 
France 


NWSS:LPHHN-S 


Copyright,  1918,  by  World  Book  Company 

Copyright  in  Great  Britain 

All  rights  reserved 


"RA 


TO 

MY    FATHER   AND    MY    MOTHER 
DR.    WILLIAM   FONTAINE   LIPPITT 

AND 
MART  LOUISA   LIPPITT 

whose  wisdom  and  care  brought  me  from 
delicate  childhood  to  healthy  womanhood, 
and  whose  teachings  have  served  as  a 
guide  to  me  in  the  preparation  of  this  work 


INTRODUCTORY   NOTE 

As  I  look  back  over  years  spent  in  a  medical  practice  confined 
largely  to  patients  suffering  from  a  moderate  degree  of  chronic 
invalidism  and  nutritional  disorders,  certain  facts  present  them- 
selves in  a  striking  way.  First,  that  the  cause  of  this  depleted 
health  is  almost  always  the  result  of  a  lack  of  knowledge  and 
consequent  failure  to  conform  to  natural  laws.  Second,  that 
whatever  measure  of  success  results  from  the  treatment  of  such 
cases  is  due,  almost  entirely,  to  the  establishment  of  a  scheme  of 
living  suited  to  the  individual  case.  The  patient  is  entered  upon 
a  course  of  progressive  upbuilding,  being  instructed  as  to  diet, 
bathing,  exercise,  rest,  and  amount  and  character  of  work.  With 
careful  and  explicit  instruction  and  with  guidance  from  week  to 
week,  the  results  in  most  cases  are  excellent,  the  patient  gaining 
in  weight  and  strength.  Little  or  no  medicine  is  required,  and  it 
is  gratifying  to  see  the  interest  of  the  average  person  in  the  plan 
of  treatment  and  his  enthusiasm  in  carrying  it  out. 

The  results  secured  in  such  cases  clearly  indicate  that  great 
benefits  would  follow  general  instruction  of  our  people  in  the  art 
of  right  physical  living,  and  there  is  now,  especially  since  the 
outbreak  of  the  great  war,  an  increasing  desire  for  knowledge  of 
this  kind.  It  is  wholesome  and  encouraging  that  it  should  be  so, 
and  it  is  especially  gratifying  that. many  of  our  girls  and  women 
are  receiving  instruction  in  how  to  preserve  their  own  health  and 
the  health  of  those  dependent  on  them.  It  is  a  move  in  the  right 
direction,  and  great  good  will  come  of  it. 

The  author  of  this  book  is  unusually  well  qualified  to  write  for 
girls  and  women  in  regard  to  matters  of  health,  as  I  from  personal 
acquaintance  know.  She  is  writing  her  own  first-hand  knowledge 
and  experiences,  and  the  book  should  fill  a  greatly  felt  need  and  be 
of  unusual  value  to  those  desiring  to  know  how  best  to  live  and 
how  to  keep  well. 

WILLIAM  EARL  CLARK,  M.D. 

WASHINGTON,  D.C. 


CONTENTS 

CHAPTER  PAGE 

1.  HEALTH  GETTING  AND  HEALTH  KEEPING  i 

2.  BATHING  —  CARE  OF  THE  SKIN  AND  HAIR    ....        4 

3.  CARE  OF  THE  MOUTH  AND  TEETH 10 

4.  CLOTHING .        .20 

5.  FATIGUE  AND  How  TO  PREVENT  IT 27 

6.  HYGIENE  OF  THE  MENSES 33 

7.  CONSTIPATION 41 

8.  EARS,  THROAT,  AND  NOSE 52 

9.  COLDS 61 

10.  THE  EYES 66 

1 1 .  EFFECT  OF  POSTURE  ON  HEALTH  AND  EFFICIENCY  — -— s- —  73  , 

12.  EXERCISE  AND  EXERCISES      .        .        .        .        .        .        .88 

13.  GENERAL  HOME  NURSING 91 

14.  TEMPERATURE,  PULSE,  AND  RESPIRATION      ....      99 

15.  BED  MAKING 104 

16.  BATHING  A  PATIENT  IN  BED 116 

17.  METHODS  OF  GIVING  VARIOUS  TREATMENTS          .        .        .121 

18.  COMMUNICABLE  DISEASES 132 

19.  NURSING  COMMUNICABLE  DISEASES 138 

20.  SOME  COMMON  COMMUNICABLE  DISEASES      ....     143 

21.  TUBERCULOSIS 155 

22.  TYPHOID  FEVER  AND  PNEUMONIA 165 

23.  NON-COMMUNICABLE  DISEASES  CAUSED  BY  BACTERIA  .        .176 

24.  FOOD  FOR  THE  INVALID.    ^ .182 

25.  ADMINISTERING  MEDICINE 187 

26.  COMMON  EMERGENCIES 194 

27.  WHAT  TO  Do  IN  CASE  OF  POISONING 208 

28.  COMMON  INJURIES 217 

29.  METHODS  OF  TREATING  WC-UNDS 225 

30.  DISLOCATIONS,  FRACTURES,  AND  BANDAGES  ....    232 

31.  THE  TRAINED  NURSE 240 

INDEX 251 

vii 


PERSONAL  HYGIENE  AND 
HOME  NURSING 

CHAPTER   ONE 
HEALTH   GETTING  AND   HEALTH   KEEPING 

How  often  have  you  heard  it  said :  "I  wish  the  doctors  in 
America  were  paid  as  they  are  in  China,  to  keep  their  patients 
well  and  not  to  try  to  cure  them  after  they  become  sick."  It  is 
true  that  in  Europe  and  America  medicines  and  medical  treat- 
ments were  for  centuries  given  only  to  cure  ailments  present,  and 
most  of  us  are  yet  unwilling  to  pay  for  medical  advice  unless  we 
are  already  ill.  Yet,  during  recent  years  physicians  have  been  de- 
voting much  time  to  searching  out  the  causes  of  disease  and  to 
finding  how  to  keep  those  already  in  health  from  becoming  ill. 
These  attempts  at  preventing  sickness  have  been  so  amazingly 
successful  that  where  all  our  modern  knowledge  is  applied  we 
are  now  able  not  only  to  control  most  communicable  diseases 
but  also  to  prevent  many  of  the  chronic  diseases  of  middle  and 
later  life.  Even  the  layman  now  recognizes  that  in  the  field  of 
health,  prevention  is  more  effective  than  cure,  and  to  a  very 
marked  extent  we  are  using  our  physicians  to  keep  us  weU  rather 
than  to  cure  us  after  we  become  ill. 

A  full  history  of  the  advances  in  medicine  and  surgery  that  have 
been  made  during  the  last  half  century  is  not  only  most  interest- 
ing, but  is  as  thrilling  as  a  tale  of  adventure.  Many  of  those  who 
have  investigated  the  origin  and  transmission  of  disease  have 
worked  without  financial  reward,  and  some  have  even  risked 
their  lives  deliberately  that  others  might  be  saved  from  illness 
and  death.  Among  these  may  be  mentioned  Dr.  James  Carroll, 
who  exposed  himself  to  the  bite  of  the  yellow-fever  mosquito 
and  thus  contracted  the  disease;  Dr.  Jesse  Lazear,  who  died 
from  the  same  disease;  and  Dr.  Walter  Reed,  who  risked  his 


2  Personal  Hygiene  and  Home  Nursing 

life  to  prove  the  mosquito  the  carrier  of  the  yellow-fever  germ. 
By  the  researches  and  heroic  work  of  these  men  and  their 
co-workers,  Havana  was  made  healthful,  the  Panama  Canal 
became  possible,  and  the  world  was  given  a  shining  example  of  the 
value  of  preventive  measures  when  applied  to  problems  of  health. 

Necessity  for  teaching  hygiene  to  the  young.  Gradually  doc- 
tors and  others  who  have  interested  themselves  in  the  prevention 
of  illness  have  come  to  realize  that  to  keep  people  in  health  during 
their  more  active  years  and  to  prevent  their  becoming  invalids 
in  later  life,  it  is  necessary  to  teach  right  habits  of  living  to  the 
young  and  to  give  them  a  right  attitude  of  mind  toward  questions 
of  health.  The  things  in  life  that  we  have  always  had,  or  that 
come  to  us  easily,  we  do  not  value  enough,  and  perhaps  it  is  be- 
cause nature  has  been  so  generous  in  giving  us  healthy  bodies 
that  we  do  not  realize  the  possibility  of  injuring  them.  A  strong, 
healthy  girl  frequently  receives  with  impatience  a  suggestion  that 
she  should  take  care  of  herself;  she  feels  that  nothing  can  hurt 
her,  and  so  she  recklessly  throws  away  by  little  foolish  acts,  some- 
times thoughtless,  sometimes  deliberate,  the  health  which,  after 
it  is  gone,  she  realizes  was  the  foundation  of  everything  worth 
having  in  life. 

One  of  the  trials  that  older  people  have  to  bear  is  to  see  girls 
and  boys  injuring  their  health  in  this  way,  receiving  advice  with 
impatience  and  continuing  to  make  the  same  mistakes  that  their 
fathers  and  mothers,  perhaps,  made  in  their  youth,  and  for  which 
they  are  paying  now.  In  my  experience  I  have  found  it  true  in 
most  cases,  that  if  a  girl  is  taught  something  of  her  body  and  the 
care  of  it  and  of  the  results  following  its  neglect,  she  will  make  an 
effort  to  live  the  life  that  she  should,  observing  the  laws  of  personal 
hygiene,  not  spending  all  her  health  and  strength  in  her  youth, 
but  laying  up  some  of  it  to  use  in  her  future  life  when  the  calls 
upon  it  may  be  heavy.  Therefore  in  these  chapters  the  attempt 
is  made  not  only  to  teach  how  to  live,  but  to  make  clear  the  reasons 
for  so  living. 


Health  Getting  and  Health  Keeping  3 

Health  needed  by  the  woman  of  today.  A  generation  or  two 
ago,  we  are  told,  a  delicate  woman  was  considered  quite  interest- 
ing, and  fainting  gracefully  was  an  accomplishment  to  be  culti- 
vated. But  the  woman  of  today  cannot  afford  to  be  delicate; 
there  is  too  much  to  interest  her,  and  too  much  that  she  wants  to 
be  able  to  do  and  do  well.  A  healthy  body,  doing  its  work  without 
effort,  enables  one  to  accomplish  and  endure,  and  leaves  the  mind 
free  to  develop.  Women  are  now  forced  by  the  war  to  enter  many 
new  positions  which  up  to  this  time  have  been  filled  by  men,  and 
in  these  new  positions  they  are  accomplishing  a  great  deal.  You 
do  not  want  to  be  behind  in  the  race ;  and  since  good  health  means 
greater  efficiency,  either  at  home  or  in  business,  you  should  run 
no  risk  of  losing  your  health,  nor  hesitate  at  any  effort  that  will 
help  you  to  attain  health  if  you  do  not  have  it. 

Knowledge  of  health  getting  and  health  keeping,  though  simple 
in  itself,  is  so  often  buried  in  big  medical  books  and  obscured  by 
-technicalities  that  in  many  cases  it  is  kept  from  those  who  need  it. 
With  the  hope  of  giving  to  girls  and  women  practical  instruction 
for  daily  life,  in  terms  clear  to  every  one,  this  book  has  been  written. 
Its  purpose  is  to  explain  how  a  girl  may  attain  health  and  happiness 
in  the  present  and  lay  the  foundation  for  a  sane  and  vigorous  old 
age ;  to  give  directions  for  preventing  the  spreading  of  infection 
from  cases  of  communicable  diseases ;  and  to  furnish  instruction 
in  caring  for  oneself  and  one's  family  in  time  of  accident  or  sickness 
in  the  home. 


CHAPTER   TWO 


BATHING  — CARE   OF   THE   SKIN   AND   HAIR 

CIVILIZATION  has  been  roughly  denned  as  the  difference  between 
the  washed  and  the  unwashed.  Frequent  bathing  is  necessary  to 
proper  standards  of  living,  but  baths  may  also  have  an  important 
relation  to  the  health.  The  details  of  taking  them  must  differ 
with  the  individual,  however,  for  nearly  every  kind  of  bath  is 
beneficial  to  some  people  and  harmful  to  others.  For  most  per- 
sons a  daily  bath  is  agreeable  as  well  as  wholesome ;  but  for  some 
a  daily  bath  is  too  drying  to  the  skin,  and  causes  roughness  and 
even  fissures  in  the  cuticle.  Keeping  clean  is  an  important  matter, 
but  the  ways  and  means  of  keeping  clean  should  be  such  as  are 
best  suited  to  the  individual  constitution. 

The  skin  and  its  functions.  The  skin  is  composed  of  two  layers : 
the  epidermis,  or  outer  layer,  and  the  dermis,  or,  as  it  is  generally 


hair 


oil 


touch 


gland      epidermis    corpuscle 


derm  is 
FIG.  i. 


sweat   fat     ne 
gland 
A  section  of  the  skin. 


called,  the  "  true  skin."  The 
outer  layer  is  constantly  re- 
newed by  an  imperceptible 
process  of  growth,  the  old  skin 
being  rubbed  off  by  the  clothing 
and  in  bathing.  The  skin  con- 
tains glands  which  secrete  per- 
spiration, and  others  which 
secrete  an  oily  substance  that 
keeps  the  skin  and  the  hair  soft. 
The  latter  are  called  the  seba- 
ceous glands.  The  oil  from  the 
sebaceous  glands,  with  perspira- 
tion and  dust,  becomes  mixed 
with  the  old  skin,  and,  unless 
removed  by  bathing,  it  forms  a 
breeding  place  for  germs,  which 
cause  blackheads,  pimples,  and 
various  skin  diseases. 


Bathing  —  Care  of  the  Skin  and  Hair  5 

The  skin  has  four  functions.  It  forms  a  protective  covering 
for  the  body;  it  helps  through  the  secretion  of  perspiration  to 
regulate  the  heat  of  the  body ;  it  is  an  organ  of  touch  and  for  the 
perception  of  temperature  and  pain;  and  it  eliminates  some  of 
the  water  and  a  small  part  of  the  waste  products  of  the  body. 
The  daily  bath  keeps  the  pores  of  the  skin  from  becoming  clogged 
and  prevents  the  odor  of  perspiration,  and  baths  may  be  used 
to  train  the  skin  in  the  better  regulation  of  the  body  heat. 

The  cold  bath.  Most  persons  find  that  a  cold  bath  taken  in 
the  morning  creates  appetite,  improves  the  circulation,  arouses 
the  sympathetic  nervous  system,  and  is  very  exhilarating.  A 
cold  tub  bath  should  be  quickly  taken,  —  merely  a  dip,  —  or  the 
cold  bath  may  be  taken  as  a  shower  or  douche.  Certain  conditions 
should  always  be  fulfilled :  (i)  the  body  should  be  warm ;  (2)  the 
bath  should  be  taken  in  a  warm  room ;  (3)  one  must  be  able  to 
react,  becoming  thoroughly  warm  after  the  shock  of  the  cold  water. 
After  the  bath  the  skin  should  be  well  rubbed  with  a  coarse  towel. 
Sometimes  slapping  the  body  all  over  with  the  hands  helps  to  warm 
it.  The  best  time  for  the  cold  bath  is  immediately  after  getting 
out  of  bed,  or  after  exercise  which  has  quickened  the  circulation 
and  warmed  the  body.  For  many  people  the  best  plan  is  to  warm 
the  body  by  a  hot  bath,  and  to  get  the  stimulation  by  a  cold  shower 
at  the  end. 

The  cold  bath  should  not  be  taken  in  old  age,  or,  except  in  very 
rare  cases,  in  infancy.  It  should  not  be  taken  when  one  is  ex- 
cessively tired  or  has  not  slept  well,  or  when,  on  account  of  illness 
or  exposure  to  cold,  the  temperature  of  the  body  is  low,  or  if  the 
application  of  cold  water  is  a  severe  shock  and  there  is  extreme 
shrinking  from  it.  If  the  bath  is  followed  by  a  chill,  or  if,  though 
apparently  warming  well  after  taking  it,  one  is  fatigued  and  chilly 
through  the  day,  the  cold  bath  is  not  beneficial.  Sometimes  a 
cold  sponge  bath  in  a  warm  room,  or  a  cold  shower  after  a  hot 
bath,  is  an  agreeable  stimulus  to  those  who  cannot  react  after  a 
cold  tub. 


6  Personal  Hygiene  and  Home  Nursing 

The  hot  bath.  To  most  persons  a  hot  bath,  taken  at  night  after 
a  fatiguing  day,  is  refreshing  and  healthful.  It  draws  the  blood 
away  from  the  muscles  to  the  skin,  taking  from  the  muscles  the 
feeling  of  soreness,  and  causes  a  general  feeling  of  relaxation  and 
rest.  For  exactly  the  same  reasons  the  bath  should  not  be  taken 
soon  after  a  full  meal,  as  the  blood  is  drawn  away  from  the  diges- 
tive organs.  At  least  one  hour  should  elapse  between  the  meal 
and  the  bath.  With  some  persons  the  effect  of  the  hot  bath  is 
stimulating  rather  than  soothing,  and  if  taken  just  before  retiring 
it  will  keep  them  awake  all  night.  When  this  is  the  case,  the  hot 
bath  should  be  taken  earlier  in  the  evening.  Sometimes  a  glass 
of  milk  or  some  other  light  refreshment  after  the  bath  will  prevent 
wakefulness ;  at  such  times  hot  milk,  hot  soup,  or  hot  cocoa  are 
better  than  cold  food. 

A  hot  bath  is  frequently  good  for  a  cold,  but  must  be  taken 
in  the  right  way  if  it  is  to  be  of  use.  All  preparations  for  bed 
should  be  made  before  taking  the  bath,  —  the  bed  covers  should 
be  turned  down,  the  windows  opened,  extra  covers  placed  at  hand, 
and  everything  else  prepared.  To  wander  around  the  room, 
brushing  your  hair,  looking  for  a  hot-water  bag  and  filling  it,  and 
doing  other  odd  jobs,  after  relaxing  in  the  bath,  means  that  the 
bath  will  not  only  do  no  good,  but  probably  make  the  cold 
worse. 

The  tepid  bath.  If  one  takes  a  tepid  bath  daily,  it  is  not  well 
to  stay  in  the  water  for  more  than  five  minutes.  Tepid  water 
does  not  stimulate  the  body,  and  staying  in  the  bath  too  long  will 
cause  a  relaxed  condition  of  the  muscles  and  a  certain  feeling  of 
lassitude. 

Sometimes  a  physician  orders  a  tepid  bath  to  be  taken  at  night, 
to  cause  relaxation  and  counteract  the  condition  of  insomnia. 
In  this  case  one  may  remain  in  the  water  for  ten  or  fifteen  minutes. 
Keeping  the  water  in  motion,  by  letting  it  run  in  from  the  faucet 
and  out  at  the  waste  while  one  is  in  the  tub,  is  very  soothing  and 
conducive  to  sleep. 


Bathing  —  Care  of  the  Skin  and  Hair  7 

Special  baths.  Salt  baths,  perfumed  baths,  and  other  luxuries 
of  bathing  are  by  no  means  unattainable  in  the  average  home. 
Generally  speaking,  whatever  makes  a  bath  pleasant  and  agrees 
with  the  conditions  of  general  health  is  worth  a  little  extra  trouble. 
Sometimes  the  water  is  hard,  and  must  be  softened  by  using  the 
proper  kind  of  soap,  or  the  skin  will  become  rough  and  chapped. 
The  flesh  brush  and  the  nail  brush  are  necessary  to  perfect  clean- 
liness. 

Special  attention  should  be  paid  to  the  feet,  for  negligence  here 
will  result  in  all  sorts  of  pain  and  trouble.  Hot  foot  baths  do 
much  to  relieve  fatigue.  If  hot  water  is  not  available,  and  the 
feet  are  hot  and  dusty,  they  should  be  sponged  off  with  cold  water. 
If  the  feet  are  swelled  and  the  muscles  sore  and  painful,  the  most 
efficacious  bath  is  that  of  alternating  hot  and  cold  water.  When 
taking  this  bath,  the  feet  are  dipped,  first  in  cold  water,  then  in 
hot,  changing  from  one  to  the  other  fifteen  or  twenty  times.  There 
are  two  ways  of  taking  this  type  of  foot  bath.  In  one  method 
two  bowls  are  used,  one  filled  with  hot  water,  one  with  cold.  The 
other  method  is  to  fill  one  bowl  with  hot  water  and  set  it  in  a  large 
bathtub ;  then,  sitting  on  the  edge  of  the  tub,  turn  on  the  cold- 
water  faucet  and  hold  the  foot  first  under  the  running  cold  water 
and  then  in  the  hot  water,  changing  quickly  from  one  to  the  other 
and  ending  with  the  cold  water. 

Care  of  the  complexion.  The  skin  of  the  face  needs  special 
care  to  keep  it  in  a  healthy  condition.  Being  uncovered,  it  is 
constantly  exposed  to  the  sun,  wind,  and  cold.  At  night,  before 
retiring,  the  face  must  be  thoroughly  washed  to  remove  the  dust 
and  dirt  of  the  day.  Bathing  first  in  hot  water,  then  in  cold,  is 
refreshing  and  stimulating  to  the  skin.  Blackheads  frequently 
form  around  the  nose  if  the  skin  is  not  kept  clear  by  bathing. 
After  the  bath  rub  the  face  with  a  good  cold  cream,  rubbing  in 
small  circles  and  working  upward,  and  removing  the  surplus  cream 
with  a  soft  towel  or  cloth.  A  quick  sponge  with  cold  water  into 
which  a  little  good  toilet  water  has  been  poured  will  be  refreshing 


8  Personal  Hygiene  and  Home  Nursing 

and  stimulating  after  the  face  has  been  bathed  in  hot  water.  Be- 
fore going  out  into  the  sun  or  wind,  rub  in  a  little  cold  cream, 
removing  the  surplus  cream  with  soft  linen,  and  powder  lightly. 
When  you  are  working  over  a  stove,  a  little  cold  cream  is  good  to 
prevent  burning. 

It  is  not  wise  to  use  creams,  soaps,  and  face  lotions  which  happen 
to  be  well  advertised  for  the  moment,  but  of  which  you  really  know 
nothing.  Choose  those  made  by  a  good  firm  with  a  reputation 
to  sustain,  or  ask  your  doctor  to  recommend  a  brand  sure  to  be 
harmless.  If  you  are  troubled  with  acne  or  pimples,  it  is  best 
to  go  to  a  regular  physician  who  is  a  skin  specialist  and  not  a 
"  beauty  doctor."  Many  complexions  have  been  ruined  by  home 
treatments  and  patent  medicines. 

Cosmetics  are  not  always  injurious  to  the  skin.  A  girl  who 
uses  them,  however,  not  only  shows  bad  taste  but  invites  much 
disagreeable  comment.  Few,  if  any,  of  those  who  see  the  made-up 
complexion  are  deceived,  and  except  on  the  stage  a  really  artistic 
make-up  is  seldom  seen.  The  artificial  lights  of  the  theater  de- 
mand paint  and  powder,  but  even  here  the  best  actresses  use  the 
make-up  box  as  little  as  possible,  and  they  get  rid  of  the  paint  at 
the  earliest  opportunity  because  they  know  what  it  does  to  the 
skin.  If  the  girl  who  paints  and  covers  her  face  with  powders 
could  read  the  thoughts  of  those  who  meet  her,  she  would  seldom 
be  able  to  resume  the  practice  with  any  comfort.  There  are  few 
things  more  beautiful  than  the  healthy  glow  of  a  young  girl's  skin, 
and  cosmetics,  no  matter  how  skillfully  applied,  can  never  pro- 
duce the  same  effect.  A  pale  or  sallow  skin  in  a  young  person  is 
most  often  caused  by  some  condition  of  the  body  which  has  been 
brought  about  by  neglect  of  the  laws  of  hygiene ;  and  it  is  by  im- 
proving the  condition  of  her  health  that  a  girl  will  make  her  com- 
plexion what  it  ought  to  be. 

The  care  of  the  complexion  must  often  begin  with  attention 
to  the  general  health,  for  no  part  of  the  skin  is  more  directly  af- 
fected by  indigestion,  lack  of  exercise,  neglect  of  bathing,  or  ex- 


Bathing  —  Care  of  the  Skin  and  Hair  9 

cessive  fatigue  than  is  the  skin  of  the  face.  The  bowels  should 
be  kept  regular,  indigestible  food  avoided,  and  the  pores  of  the 
skin  of  the  whole  body  kept  clear  by  bathing.  By  drinking  plenty 
of  water  through  the  day  and  thus  "  flushing  "  the  canals  of  the 
body,  the  accumulation  of  waste  is  avoided.  If  these  matters 
receive  due  attention,  with  good  exercise  in  the  open  air,  and  deep 
breathing  practiced  daily,  the  complexion  should  be  clear  and 
glowing  if  not  brilliant.  If  sallowne'ss  or  other  defects  persist 
after  all  this,  there  is  probably  ill  health  from  some  other  cause, 
and  the  advice  of  a  doctor  should  be  asked. 
-'cCare  of  the  Viands.  The  hands  should  be  washed  often,  and 
especially  before  eating.  The  nails  should  be  scrubbed  with  a 
brush  and  cleaned  with  an  orange  stick.  The  fingers  should  not 
be  put  into  the  mouth  unless  they  have  just  been  washed,  as  they 
have  constantly  touched  things  which  may  have  been  touched 
and  infected  by  others.  Rubbing  cold  cream  into  the  hands 
helps  to  keep  them  soft  and  free  from  cracks.  Some  soaps  dry 
the  skin  too  much.  If  you  are  troubled  with  dry  or  chapped  skin, 
select  your  soap  with  special  care. 

3,  Care  of  the  hair.  The  hair  should  always  be  taken  down  and 
brushed  at  night.  If  it  is  left  rolled  up  on  the  head,  the  heating 
and  strain  on  the  roots  are  likely  to  cause  it  to  fall  out,  and  some- 
times a  bald  spot  may  appear  at  the  point  where  the  hair  is  pinned 
up.  Brushing  removes  the  dust  and  dirt  which  has  lodged  in  it 
during  the  day,  stimulates  the  circulation  in  the  scalp,  and  softens 
the  hair  by  spreading  over  it  oil  from  the  sebaceous  glands.  The 
hair  should  be  washed  at  least  once  in  two  months,  and  oftener  if 
it  is  not  brushed  daily.  If  an  abnormal  amount  of  hair  falls  out, 
steps  should  be  taken  to  check  the  loss.  Massage  is  the  best 
treatment  for  the  scalp,  and  a  little  tonic  may  be  rubbed  into  the 
scalp  at  least  once  a  week.  Never  use  a  comb  or  brush  which  has 
been  used  by  others.  Dandruff,  a  common  germ  disease  of  the 
scalp,  is  easily  spread  through  brushes  and  combs. 


CHAPTER   THREE 

CARE   OF  THE   MOUTH   AND  TEETH 

IN  spite  of  the  fact  that  the  medical  profession  has  realized  for 
some  time  that  an  unhealthy  condition  of  the  mouth  and  teeth  is 
a  cause  of  both  acute  and  chronic  diseases,  it  has  been  a  difficult 
matter  to  make  the  people  understand  the  necessity  of  giving 
proper  care  to  their  mouths.  Of  course  most  persons  are  taught 
that  the  teeth  must  be  cleaned  night  and  morning,  but  they  think 
of  this  as  "  something  that  all  ladies  and  gentlemen  do  "  rather 
than  as  a  most  important  hygienic  practice. 

Because  we  have  learned  that  when  the  teeth  decay,  centers  of 
infection  are  established  that  may  remain  for  years  about  the 
roots  of  the  teeth  and  in  the  bones  of  the  face,  and  that  these  in- 
fections lead  to  serious  diseases  of  the  heart,  kidneys,  and  other 
organs,  mouth  hygiene  has  now  come  to  occupy  an  important 
place  in  any  program  of  health  work. 

Importance  of  preventing  tooth  troubles.  In  the  oral  hygiene 
movement  which  has  been  so  prominent  in  recent  years,  the  entire 
emphasis  is  placed  on  prevention.  While  the  teeth  are  yet  sound 
is  when  the  work  should  be  done  on  them.  After  decay  has  set 
in,  the  damage  can  be  remedied  only  in  part ;  and  when  the  germs 
have  made  their  way  into  the  root  canals  and  the  bones  of  the  jaw, 
the  highest  dental  skill  is  required  to  eradicate  them.  Many  of 
the  teeth  that  have  been  filled  or  crowned  after  removing  the  pulp 
and  treating  the  cavity  still  have  areas  of  infected  bone  about 
their  roots,  and  not  a  few  medical  men  have  felt  that  on  the  whole 
as  much  harm  as  good  has  been  done  by  the  crowns  and  bridges 
that  dentists  have  placed  in  the  mouths  of  their  patients  during 
the  past  years.  On  this  account  there  is  igreat  insistence  that  the 
teeth  be  properly  cared  for  from  earliest  childhood,  so  that  they 
will  come  into  the  mouth  in  their  proper  places  and  remain  firm 
and  sound. 

The  care  of  a  baby's  mouth.  A  baby's  mouth  should  be  washed 
after  each  feeding,  not  merely  night  and  morning.  This  must  be 


Care  of  the  Mouth  and  Teeth  n 

carefully  done,  as  the  mucous  membrane  of  an  infant's  mouth  is 
very  tender.  The  nurse  or  mother  should  wrap  a  piece  of  absorbent 
cotton  around  the  first  finger,  and  then,  dipping  the  cotton  in 
either  sterile  water  or  a  saturated  solution  of  boric  acid,  wash 
thoroughly  but  gently  all  parts  of  the  mouth.  Especial  care 
should  be  taken  to  pass  the  cotton  over  and  under  the  tongue  and 
between  the  gums  and  cheeks,  since  coagulated  milk  is  most  likely 
to  lodge  in  these  places.  The  hands  should  be  thoroughly  washed 
and  the  nails  trimmed  and  cleaned  before  beginning  the  work,  so 
that  there  will  be  no  possibility  of  carrying  germs  into  the  mouth 
of  the  infant  or  of  lacerating  the  gums  with  the  nails. 

All  feeding  utensils  and  apparatus  used  in  connection  with  an 
infant's  food  should  be  boiled,  and  if  the  mouth  becomes  sore  the 
attention  of  the  physician  should  be  called  to  it  at  once,  for  the 
child  may  be  prevented  from  nursing  as  it  should  and  its  health 
be  interfered  with  in  this  way.  Thrush  and  stomatitis  are  two 
diseases  which  may  follow  carelessness  in  the  care  of  an  infant's 
mouth. 

The  care  of  the  first  or  temporary  teeth.  As  soon  as  the  first 
teeth  appear,  they  should  be  looked  after  as  carefully  as  the  teeth 
of  an  adult.  The  mouth  and  teeth  should  be  washed  at  least 
twice  a  day,  and,  after  the  child  begins  to  eat,  four  times  a  day. 
A  small  brush  with  soft  bristles  should  be  used.  After  all  the 
temporary  teeth  are  in  place,  the  child  should  be  taken  to  a  den- 
tist from  time  to  time,  in  order  that  the  teeth  may  be  watched 
by  him,  cleaned,  and  filled  when  necessary.  It  is  very  important 
that  the  temporary  teeth  be  preserved,  for  several  reasons :  (i)  The 
pain  associated  with  decayed  and  aching  teeth  causes  nervousness 
and  loss  of  sleep.  (2)  If  the  teeth  are  not  filled,  abscesses  in  the 
gums  may  develop  which  may  materially  affect  the  child's  health. 
(3)  Premature  loss  of  the  first  teeth  frequently  interferes  with 
normal  growth  of  the  jaws  and  causes  malocclusion  or  irregularity 
of  the  permanent  teeth.  (4)  As  the  permanent  teeth  push  down 
in  the  jaws,  the  roots  of  the  temporary  teeth  are  absorbed  before 


12  Personal  Hygiene  and  Home  Nursing 

them.  If  a  temporary  tooth  is  dead  the  roots  are  not  absorbed, 
and  unless  the  tooth  is  extracted  the  permanent  tooth  will  come 
through  inside  or  outside  of  it. 


FIG.  2.     A  small  brush  with  which  all  the  surfaces  of  the  teeth  may  be  cleaned. 

Other  conditions  which  cause  irregularity  of  the  teeth  are  mouth 
breathing  due  to  adenoids  and  enlarged  tonsils  or  to  malformation 
of  the  bones  within  the  nose ;  sucking  of  the  thumbs  or  fingers ; 
or  lack  of  proper  use  of  the  teeth,  owing  to  open  cavities  in  them 
or  to  loss  of  some  of  them. 

The  permanent  teeth.  At  about  the  sixth  year  the  first  perma- 
nent molar  appears,  and  then  the  other  permanent  teeth  gradually 
take  their  places,  until  at  the  age  of  twelve  all  but  the  wisdom  teeth 
are  in  the  mouth.  The  wisdom  teeth  may  come  as  early  as  at  the 
age  of  sixteen  or  may  not  appear  until  well  toward  middle  life,  and 
sometimes  some  of  them  do  not  appear  at  all. 

The  largest  and  most  important  of  the  permanent  teeth  are  the 
six-year  molars.  During  the  time  when  the  temporary  teeth  are 
being  lost  they  do  most  of  the  mastication,  and  they  are  the  guides 
by  which  the  other  permanent  teeth  are  brought  into  their  proper 
places.  They  have  deep  pits  in  their  surfaces,  which  hold  food 
and  are  apt  to  lead  to  decay,  and  therefore  they  need  to  be  care- 
fully watched.  It  is  especially  important  that  these  teeth  be  pre- 
served and  kept  in  their  right  places,  for  if  they  are  lost  or  out  of 
place  the  rest  of  the  teeth  are  likely  to  be  irregular.  One  reason 
for  giving  the  baby  molars  special  care  is  because  if  they  are  lost 
the  six-year  molars  are  likely  to  crowd  forward  and  not  leave 
enough  room  for  the  other  permanent  teeth  that  will  come  into 
the  mouth  in  front  of  them.  As  a  consequence,  some  of  these 
will  come  through  in  front  of  or  behind  the  dental  arch,  and  the 
line  of  teeth  will  be  irregular.  These  irregularities  should  be  pre- 


Care  of  the  Mouth  and  Teeth  13 

vented  by  preserving  the  teeth  from  decay,  but  if  they  appear 
they  should  be  attended  to  early.    It  is  better  for  the  teeth  to 


FIGS.  3-4.    In  brushing  the  teeth  the  movement  of  the  brush  should  be  away  from 
and  not  toward  the  gums. 

be  forced  to  grow  into  their  right  positions  than  to  be  straightened 
later. 

Cleaning  the  teeth.  The  teeth  should  always  be  cleaned  at 
least  twice  daily,  of tener  when  possible,  and  after  each  meal  should 
be  rinsed  with  tepid  water  or  salt  and  water  to  remove  all  particles 
of  food  which  may  have  lodged  between  them.  It  is  well  to  brush 
the  teeth  and  rinse  the  mouth  with  tepid  salt  water  in  the  morning 
before  breakfast.  The  gums  should  be  brushed  as  well  as  the 
teeth,  for  they  need  a  certain  amount  of  friction  to  keep  them 
healthy.  A  brush  with  medium  stiff  bristles  is  best,  and  if  decay 
is  to  be  prevented  all  the  surfaces  of  the  teeth  must  be  reached. 

The  brush  and  its  care.  Most  of  the  brushes  used  for  cleaning 
the  teeth  are  too  large,  making  it  difficult  to  cleanse  properly  the 
back  teeth,  where  the  space  is  narrow  between  the  jaws  and  the 
cheeks.  An  adult  should  use  a  brush  almost  as  small  as  the  brush 
which  is  usually  sold  for  a  child,  and  any  one  who  has  once  be- 
come accustomed  to  a  brush  of  that  size  and  has  experienced  the 
feeling  of  cleanness  that  the  mouth  has  after  its  use,  will  never 
again  be  satisfied  to  use  a  larger  one.  There  is  a  small  brush  with 
a  slender  curved  handle  and  a  tuft  of  bristles  only  as  big  as  the 
end  of  the  finger,  which  is  made  to  use  in  cleaning  the  inside  of 
the  teeth  and  around  the  wisdom  teeth  and  molars.  This  brush 


Personal  Hygiene  and  Home  Nursing 


is  very  satisfactory,  and  with  it  and  a  larger  brush  one  may  clean 
all  the  surfaces  of  the  teeth  most  thoroughly. 

It  is  best  to  have  two  sets  of 
brushes,  one  for  the  morning 
and  one  for  the  evening.  This 
allows  the  brushes  to  dry  thor- 
oughly and  restores  their  effi- 
ciency. The  brush  should  be 
thoroughly  washed  out  after  use 
—  if  possible,  rinsed  under  a 
forcible  stream  to  cleanse  it 
from  all  powder,  paste,  or  par- 
ticles of  food  which  may  remain 
in  it.  Hang  the  brush  up  away 
from  dust  and  other  brushes. 

Correct  method  of  using  the 
brush.  In  cleaning  the  teeth, 
place  the  brush  upon  the  gum 
and  then,  with  the  upper  and  lower  teeth  held  slightly  apart, 
bring  the  brush  with  a  rotary  motion  down  to  the  end  of  the 
teeth.  Clean  first  the  upper  teeth  and  then  the  lower,  each  set 
separately.  The  brush  should  never  be  brought  from  the  upper 
teeth  down  over  the  lower  or  from  the  lower  up  over  the 
upper,  as  by  this  method  particles  of  food  are  forced  under 
the  edges  of  the  gum.  The  rotary  movement  causes  the  hairs 
of  the  brush  to  penetrate  between  the  teeth  and  thoroughly 
cleans  in  between  them.  The  inside  of  the  teeth  is  cleaned 
with  the  small  brush,  turning  it  with  the  same  rotary  move- 
ment. Brush  the  masticating  surfaces  of  the  teeth  with  an 
in-and-out,  side-to-side  movement.  This  cleans  the  pits  and 
grooves. 

Tooth  pastes  and  powders.  Mouth  washes,  powders,  and 
pastes  are  of  little  good  as  disinfectants,  but  they  help  to  clean 
the  teeth  and  mouth  and  leave  a  pleasant  taste.  No  gritty  powders 


FIG.  5.     Correct  position  of  the  brush  in 
cleaning  the  inside  of  the  front  teeth. 


Care  of  the  Mouth  and  Teeth 


Walttr  E.  Fancher,  D.D.S. 
FIG.  6.  Radiograph  of  aching  molar. 
The  light  area  around  the  roots  of  the 
tooth  in  the  center  of  the  cut  is  due  to 
bone  destruction  and  the  presence  of 
pus.  At  the  right  is  shown  a  tooth  with 
a  well-made  porcelain  crown,  but  the 
root  canal  has  not  been  perfectly  filled. 


Walter  E.  Fancher,  D.D.S. 
FIG.  7.  The  patient  experienced  no  pain 
from  any  of  the  teeth,  but  the  radio- 
graph shows  that  the  root  canal  of  the 
second  tooth  from  the  left  is  only  par- 
tially filled  and  the  light  area  at  the  root 
indicates  infection  and  the  destruction 
of  bone. 


should  be  used,  as  they  may  injure  the  enamel  and  make  the  teeth 
more  liable  to  decay. 

Use  of  toothpicks  and  silk.  A  toothpick  or  floss  silk  may  be 
used  between  the  teeth  to  remove  particles  of  food,  and  are  bene- 
ficial unless  used  with  sufficient  force  to  injure  the  gums.  Silk 
should  not  be  used  if  the  teeth  are  so  close  together  that  it  is  im- 
possible to  get  the  silk  between  them  without  using  force,  for  if 
this  is  the  case  it  is  impossible  to  prevent  the  silk  from  striking 
and  lacerating  the  gums,  thus  leaving  them  in  a  condition  in 
which  they  may  become  infected.  A  quill  toothpick  is  better 
than  one  made  of  either  wood  or  metal,  as  it  is  flexible  and  not 
so  fikely  to  injure  the  gums.  If  there  are  spaces  between  teeth 
where  particles  of  food  are  forced  and  retained,  the  trouble  can  be 
remedied  by  having  the  normal  contact  of  the  teeth  restored  by  a 
dentist. 

Preventing  the  formation  of  cavities  in  the  teeth.  The  most 
common  disease  of  the  teeth  is  dental  decay.  This  starts,  not  from 
within  the  tooth  but  from  without,  and  is  caused  by  bacteria 
growing  in  the  material  that  adheres  to  the  teeth.  The  parts 


i6 


Personal  Hygiene  and  Home  Nursing 


-  Walter  E.  Fancher,  D.D.S. 
FIG.  8.  The  second  tooth  from  the  left 
shows  a  perfect  filling  of  the  root  canal. 
The  root  was  filled  and  the  radiograph 
then  taken  to  check  up  the  work  before 
inserting  a  permanent  filling  in  the  tooth. 


of  the  teeth  most  likely  to  decay 
are  the  places  that  are  somewhat 
protected  from  friction  and  where 
food  is  left  to  ferment  and  form 
an  acid  which  destroys  the 
enamel,  or  hard  outer  coating 
of  the  tooth.  These  points  are : 
(i)  between  the  teeth,  (2)  in  the 
rough  surfaces  of  the  molars,  and 
(3)  along  the  edges  of  the  gums. 

After  the  enamel  of  the  tooth  is 
once  broken,  it  is  an  easy  matter 
for  the  bacteria  to  penetrate  into 
the  softer  part  of  the  tooth  and 
continue  the  process  of  decay.  Anything  which  injures  the  hard 
surface  of  the  tooth  will  enable  the  germs  to  enter.  Sometimes 
an  illness  during  the  time  when  the  permanent  teeth  are  develop- 
ing will  interfere  with  the  perfect  formation  of  the  enamel  and 
leave  weak  places  for  the  development  of  decay.  Keeping  the 
mouth  and  teeth  absolutely  clean  by  frequent  brushing  and  rinsing 
is  the  surest  way  to  prevent  decay.  In  addition  to  this  care,  a 
dentist  should  be  visited  four  times  a  year  and  any  material  that 
adheres  to  the  teeth  along  the  margins  of  the  gums  should  be 
removed. 

Pyorrhea  alveolaris.  Pyorrhea,  or  "  Rigg's  disease,"  as  it  is 
often  called,  is  a  disease  of  the  membrane  covering  the  roots  of 
the  teeth,  the  gums,  and  the  bony  sockets.  The  disease,  according 
to  several  authorities,  is  caused  by  an  infection  of  the  soft  tissue 
which  has  followed  a  slight  injury  to  the  gum,  or  by  a  loss  of  re- 
sistance on  the  part  of  the  gum  from  lack  of  use  or  some  systemic 
condition.  The  loss  of  one  or  more  teeth,  which  interferes  with  the 
normal  function  of  the  remaining  teeth,  is  a  predisposing  cause. 
The  presence  of  the  germs  is  of  course  a  necessary  factor,  for  the 
disease  cannot  develop  without  them.  Injuries  to  the  gums  may 


Care  of  the  Mouth  and  Teeth 


Walter  E.  Fancher,  D.D.S. 
FIG.  9.  Radiograph  of  four  lower  an- 
terior teeth,  showing  bone  destruction 
around  the  roots  due  to  pyorrhea.  The 
light  areas  about  the  roots  of  the  teeth 
are  the  infected  parts. 


Walter  E.  Fancher,  D.D.S. 
FIG.  10.  Radiograph  showing  two  pyor- 
rhea pockets  about  the  teeth.  The  first 
molar,  which  has  a  gold  crown,  is  appar- 
ently alive  and  healthy.  The  two  large 
light  areas  are  the  infected  parts. 


be  caused  by  the  improper  use  of  toothpicks,  by  improperly  fitted 
bridges  and  crowns,  by  overhanging  fillings,  by  food  which  has 
been  forced  between  the  teeth,  by  injuries  caused  by  careless  use 
of  dental  instruments,  rubber  dam,  or  clamps. 

Dr.  Rigg's  theory  was  that  the  disease  is  caused  by  the  accumula- 
tion of  tartar  about  the  teeth,  which,  extending  down  under  the 
margin  of  the  gum,  starts  an  inflammation  in  the  gum  which  causes 
it  to  shrink,  and  as  the  tartar  extends  farther  and  farther  down  on 
the  tooth  it  gradually  forces  the  gum  out  of  place.  In  some  cases 
pus  is  found  about  the  roots  of  a  tooth,  but  sometimes  the  destruc- 
tion of  the  tissue  around  will  take  place  and  the  tooth  be  loosened 
and  finally  drop  out  without  the  appearance  of  pus. 

Symptoms  of  the  disease.  The  first  symptom  recognized  is  an 
inflammation.  A  red,  spongy  appearance  of  the  gums  is  noted, 
especially  between  the  teeth.  The  gums  bleed  easily  under  pres- 
sure. Unless  the  disease  has  progressed  considerably  it  is  not 
easily  recognized,  and  its  presence  can  be  determined  only  by  a 
thorough  examination  given  by  a  good  dentist. 

Treatment.  Upon  the  first  appearance  of  the  symptoms,  the 
mouth  should  be  put  under  the  care  of  a  competent  dentist. 


1 8  Personal  Hygiene  and  Home  Nursing 

Excessive  stress  on  any  individual  teeth  should  be  noted  and  the 
stress  equally  distributed.  All  tartar  should  be  removed  and  the 
teeth  thoroughly  cleaned  and  polished.  All  cavities  should  be 
filled,  faulty  fillings  removed,  septic  teeth  which  cannot  be  steri- 
lized should  be  removed,  and  the  mouth  and  teeth  put  into  the  best 
condition  possible.  At  least  four  times  a  year  the  teeth  should  be 
inspected  and  all  necessary  work  done.  When  the  treatment  of 
pyorrhea  has  been  properly  conducted,  and  prophylactic  treat- 
ments are  given  at  frequent  intervals,  the  recurrence  of  the 
disease  is  rare,  in  case  the  home  care  of  the  teeth  is  faithfully 
adhered  to. 

Results  of  pyorrhea.  Until  recently  the  local  effect  of  pyorrhea 
upon  the  mouth  was  the  only  one  considered,  but  now  the  possi- 
bility of  the  injurious  effects  of  this  disease  upon  the  whole  system 
is  thoroughly  recognized  by  the  medical  profession. 

Pus,  septic  discharges,  toxins,  and  sometimes  the  germs  them- 
selves are  carried  all  through  the  body  by  the  blood  stream  and 
cause  such  conditions  as  appendicitis,  nephritis  (inflammation  of 
the  kidneys),  rheumatic  fever,  inflammation  of  the  intestine, 
arthritis  deformans,  hardening  of  the  arteries,  anemia,  tonsillitis, 
gastric  and  intestinal  ulcers,  carbuncles,  abscesses  in  glands  and 
other  tissues,  and  certain  types  of  heart  disease.  Because  of  the 
possibility  of  the  development  of  some  of  the  diseases  listed  above, 
one  can  see  the  absolute  necessity  of  giving  proper  care  to  the 
mouth  both  in  the  daily  cleansing  of  the  teeth  and  in  frequent 
visits  to  the  dentist,  and  should  realize  how  foolish  it  is  to  allow 
the  teeth  to  become  decayed  and  infected  because  of  the  annoy- 
ance or  possible  pain  which  one  may  suffer  while  undergoing  a 
treatment  by  the  dentist. 

Alveolar  abscess.  Another  disease  which  is  a  cause  of  infection 
throughout  the  body  is  abscesses  at  the  roots  of  the  teeth.  A 
dental  abscess  (gum  boil)  usually  follows  the  death  of  the  pulp, 
the  germs  working  up  from  the  dead  tissue  into  the  bones  of  the 
jaw.  Abscesses  may  be  acute,  when  there  is  excessive  pain  and 


Care  of  the  Mouth  and  Teeth  19 

inflammation,  or  they  may  be  chronic  and  caused  by  bacteria  of  a 
low  form  of  virulence,  with  little  inflammation  and  no  pain. 
Sometimes  a  chronic  case  will  follow  an  acute  attack  and  will 
spread  in  the  bones  of  the  jaws  and  face,  injuring  the  tissue  and 
poisoning  the  whole  system,  while  there  are  absolutely  no  symp- 
toms in  the  tooth  itself  to  give  warning  of  the  mischief  that  is 
being  done.  Abscesses  of  this  character,  can  be  detected  only  by 
the  use  of  the 'X-ray  and  are  found  only  when  some  condition  of 
the  body  arises  which  starts  a  search  for  the  source  of  infection. 

It  is  most  important  that  any  cavities  that  form  in  the  teeth  be 
filled  while  they  are  yet  small ;  for  after  the  pulp  dies  it  requires 
very  skillful  dental  work  to  save  the  tooth  and  at  the  same  time 
make  sure  that  a  center  of  infection  at  the  root  of  the  tooth  and 
in  the  bones  of  the  jaw  that  will  be  most  dangerous  to  the  general 
health  is  not  being  established.  It  is  because  of  this  fact  that 
prevention  has  come  to  occupy  so  prominent  a  place  in  the  hygiene 
of  the  mouth  and  teeth. 


CHAPTER   FOUR 


THE  choosing  and  making  of  clothing  is  a  matter  in  which  women 
seem  to  show  less  judgment  than  on  any  other  subject  relating 
to  health.  The  real  object  of  clothing  too  often  is  subordinated 
to  unnecessary  and  sometimes  inartistic  ornament.  The  best- 
dressed  woman  is  often  not  the  one  who  is  dressed  in  the  extreme 
of  the  latest  fashion,  but  the  one  whose  clothes  are  suitable  to  the 
time  and  occasion,  and  of  a  style  suitable  to  herself. 

Clothing  and  the  body  temperature.  Properly  chosen  clothing 
should  keep  the  body  at  as  even  a  temperature  as  possible.  It 
should  be  adapted  to  the  weather,  protecting  against  cold  in 
winter  and  heat  in  summer,  and  guarding  the  skin  from  sudden 
changes  in  atmospheric  conditions.  The  present-day  fashion  of 
wearing  furs  in  hot  weather  and  low  shoes,  with  thin  stockings,  in 
the  winter  is  foolish,  and  those  who  follow  it  show  little  wisdom. 
Clothing  should  also  be  suited  to  the  occasion  for  which  it  is  worn. 
A  light  wrap  is  best  for  a  rapid  walk,  as  a  heavy  wrap  is  tiring  and 
apt  to  overheat  the  body;  but  when  dressed  for  walking  one 
should  not  stand  around  out  of  doors  and  become  chilled. 

Wearing  flannels.  It  is  now  not  considered  best,  except  for 
old  people  and  little  children,  to  wear  flannel  next  the  skin.  In 
other  days,  when  street  cars  were  not  warmed  at  all,  and  houses, 
churches,  and  office  buildings  were  warmed  by  stoves,  flannels 
and  heavy  woolen  stockings  were  needed.  Today,  when  most 
houses  are  too  warm,  and  all  conveyances  in  which  one  travels 
are  heated,  too  heavy  clothing  is  not  only  unnecessary,  but,  be- 
cause of  the  perspiration  caused,  may  be  actually  harmful.  Flannel 
damp  with  perspiration  dries  but  slowly,  and  the  body  may  be- 
come chilled  if  exposed  to  cold  or  draft.  When  flannel  is  used  for 
little  children,  care  should  be  taken  that  it  is  not  too  rough  for 
the  skin.  Some  persons  cannot  wear  flannel  next  the  skin  with- 
out uncomfortable  itching.  A  rash  like  prickly  heat  may  even 
result  from  the  rubbing  of  rough  cloth  on  the  skin,  and  in  any  case 


Clothing  21 

the  nervous  irritation  of  the  itching  is  bad  for  the  child.  A  soft 
linen  or  muslin  garment  may  be  used  between  the  skin  and  the 
flannel.  The  ideal  material  for  underwear  is  a  mesh  made  of 
either  linen  or  cotton.  Underwear  made  of  this  light,  porous 
material  does  not  often  produce  a  profuse  perspiration ;  and  even 
if  this  should  happen  the  porous  material  dries  quickly,  so  that 
one  is  seldom  chilled  when  going  from  a  warm  atmosphere  to  a  cold 
one. 

The  most  sensible  costume  for  our  modern  conditions  is  one 
which  can  be  altered  to  suit  surroundings.  With  a  warm  cloak 
to  wear  out  of  doors  in  cold  weather,  a  light  silk  or  muslin  blouse 
for  the  steam-heated  or  furnace-heated  room,  and 'some  sort  of 
light  wrap  or  over-blouse  to  slip  on  if  needed,  one  is  protected 
against  the  cold  without  heavy  flannel  underwear,  and  there  is 
no  danger  of  getting  into  a  profuse  perspiration. 

Tight  clothing  injurious.  Clothing  should  not  be  worn  tight 
enough  to  interfere  with  the  circulation  or  with  the  normal  func- 
tion (action)  of  the  organs.  Corsets  worn  too  tight,  especially 
around  the  waist,  interfere  with  the  breathing  and  make  an  in- 
jurious pressure  upon  the  abdominal  organs.  High,  tight  collars 
prevent  the  proper  circulation  of  blood  in  the  vessels  of  the  neck 
and  often  cause  headaches.  Tight  shoes,  besides  deforming  and 
injuring  the  feet,  make  them  cold  because  of  the  interference  with 
the  circulation ;  and  tight  gloves  make  the  hands  cold  by  cutting 
off  the  warm  blood  from  them. 

In  hot  summer  weather  clothing  should  be  thin,  so  that  as  much 
air  as  possible  can  get  to  the  skin  to  help  in  the  evaporation  of  the 
perspiration.  Waists  made  with  an  open  neck  and  sleeves  reach- 
ing only  to  the  elbow  help  to  keep  the  body  cool.  Low  shoes  are 
cooler  than  high  ones,  and  white  canvas  shoes  are  more  comfort- 
able and  less  tiring  than  leather  shoes.  Black  absorbs  radiant 
heat  and  should  not  be  worn  when  one  is  exposed  to  the  hot  sun ; 
thin,  white  clothing  not  only  looks  cooler  but  is  cooler.  Tight 
gauze  underwear  is  warmer  than  thin,  loose  underwear.  The 


22  Personal  Hygiene  and  Home  Nursing 

head  too  should  be  protected  from  the  direct  rays  of  the  sun  by 
a  big  hat  or  parasol. 

Choosing  the  right  corset.  A  few  years  ago  the  corset  was 
thought  to  be  the  cause  of  most  of  the  ailments  from  which  women 
suffered.  Those  were  the  days  of  that  type  of  corset  which  com- 
pressed the  waist,  caused  malformation  of  the  lower  ribs,  and 
interfered  with  the  action  of  the  stomach  and  liver.  Now  physi- 
cians not  only  approve  but  recommend  the  properly  made  corset. 
The  use  of  the  corset  for  little  children  with  weak  abdominal 
muscles  and  stooped  shoulders  is  advised  by  one  prominent  physi- 
cian. The  healthful  corset  fits  close  around  the  lower  part  of  the 
abdomen  and  is  loose  above,  following  the  natural  lines  of  the 
figure.  It  supports  the  abdominal  organs  and  makes  no  pressure 
upon  the  stomach  or  in  the  region  of  the  diaphragm. 

A  really  good  corset  is  an  excellent  investment,  since  it  not 
only  looks  and  wears  well,  but  is  fitted  carefully  to  the  figure. 
Corsets  are  now  designed  for  dancing,  riding,  and  various  athletic 
exercises,  and  are  so  made  as  to  interfere  in  no  way  with  anything 
that  a  woman  may  be  called  upon  to  do. 

Care  of  the  feet.  The  care  of  the  feet  is  one  of  the  most  im- 
portant and  least  understood  of  all  the  branches  of  hygiene.  Low 
shoes,  even  slippers  and  pumps,  are  worn  by  women  and  girls  in 
cold,  wet  weather,  rubbers  are  neglected,  and  the  feet  are  allowed 
to  remain  wet  and  cold.  From  such  practices  as  these,  ill  health 
results.  Chronic  headache  may  be  caused  by  not  protecting  the 
feet  from  cold  and  wet,  especially  at  the  time  of  the  monthly  period. 
Many  women  neglect  changing  wet  shoes  and  stockings  for  dry, 
though  it  takes  at  the  most  only  five  or  ten  minutes  to  do  this. 
If  it  is  impossible  to  change  the  shoes,  as  when  going  into  the  school- 
room or  office,  one  can  always  wear  rubbers  with  gaiters  or  high 
shoes  to  keep  the  ankles  dry.  An  extra  pair  of  rubbers  kept  in 
reserve  at  the  office  will  save  wet  feet  in  case  of  a  sudden  storm. 
Damp  shoes  —  which,  the  wearer  may  insist,  are  not  really  wet  — 
are  practically  as  dangerous  as  wet  ones. 


Clothing 


Army  Medical  Museum 

FIG.  ii.  Slippers  with  French  heels. 
They  prop  the  arch  of  the  foot  up  on 
end  and  afford  a  very  insecure  support 
for  the  body. 


Army  Medical  Museum 
FIG.  12.  So-called  "common  sense" 
woman's  shoe.  The  pointed  toes 
cause  discomfort  and  disinclination  to 
walk. 


Army  Medical  Museum 
FIG.  13.  X-ray  of  woman's  foot  in 
slipper  with  French  heel.  Note  the 
distortion  of  the  bones  of  the  foot. 
Such  shoes  cause  backache,  headache, 
and  nervousness. 


Army  Medical  Museum 
FIG.  14.  X-ray  of  woman's  foot  in 
ordinary  shoe  with  pointed  toe.  The 
great  toe  is  turned  inward,  and  the 
joint  at  the  base  of  the  great  toe  is 
enlarged. 


Personal  Hygiene  and  Home  Nursing 


Army  Medical  Museum 

FIG.  15.  One  type  of  shoe  recommended  for 
women  by  the  American  Posture  League. 
The  inner  edge  is  straight,  and  there  is  ade- 
quate room  for  the  toes. 


Army  Medical  Museum 
FIG.  16.  X-ray  of  foot  in 
United  States  Army  shoe. 
This  shoe  gives  ample  room 
for  the  toes,  and  the  bones  of 
the  foot  are  in  normal  position. 


Rubbers  should  not  be  worn  unless  the  streets  are  wet,  for  they 
make  the  feet  perspire  and  are  very  tiring ;  but  when  it  is  snowing 
or  raining  a  leather  sole,  even  a  thick  one,  will  absorb  water  and 
become  damp.  A  foot  bath  and  a  pair  of  clean  stockings  and  light 
house  shoes  are  very  restful  after  a  hard  day. 

How  to  know  good  shoes.  The  injury  that  is  done  to  the  feet 
by  the  type  of  shoes  usually  worn  by  women  is  so  well  known  to 
them  all  that  it  is  not  necessary  to  enter  into  the  discussion  here ; 
but,  as  so  many  women  who  wish  to  wear  the  proper  shoes  under- 
stand so  little  about  them  and  find  them  so  difficult  to  buy,  a 
description  of  a  shoe  along  the  proper  lines  may  be  given. 

(i)  A  shoe  of  the  right  shape  and  size  should  fit  closely  at  the 
heel  and  about  the  arch,  but  it  should  be  long  enough  and  broad 
enough  for  the  foot,  giving  ample  room  for  the  toes.  The  arrange- 
ment of  bones  and  muscles  in  the  foot  is  such  as  to  make  the  foot 
both  strong  and  flexible.  This  arrangement  makes  the  foot  com- 


Clothing  25 

pressible,  and  the  foot  can  be  forced  into  a  shoe  much  too  small 
for  it.     A  corn  or  even  a  red  spot  on  the  foot  is  an  indication  of  an 


FIG.  17.    The  arch  of  the  foot,  and  how  a  high  heel  props  it  up  on  end. 

ill-fitting  shoe.  A  woman  will  suffer  in  her  feet  pain  and  discomfort 
which,  located  in  any  other  part  of  her  body,  would  drive  her 
quickly  to  a  physician  for  relief.  We  have  all  seen  many  women 
wearing  shoes  which  bound  and  injured  their  feet. 

(2)  A  shoe  should  have  a  straight  last;  that  is,  when  the  heels 
of  the  shoes  are  placed  together,  the  inner  borders  of  the  soles 
should  touch  each  other  at  shank  and  toe. 

(3)  The  heel  should  be  of  proper  height  to  suit  the  wearer.     A 
mistake  that  is  frequently  made  is  getting  shoes  with  the  heels 
too  low,  especially  when  one  has  been  accustomed  to  wearing  a 
shoe  with  a  high  heel.     The  muscles  of  the  leg  and  the  foot  that 
have  grown  accustomed  to  the  high  heel  are  strained  by  too  sudden 
a  change  to  a  very  low  heel.     This  is  one  reason  why  so  many 
people  will  say  that  they  cannot  wear  a  "  common  sense  "  shoe, 
because  of  the  fatigue,  even  the  pain,  which  has  followed  the  at- 
tempt.    The  heel  should  be  properly  placed,  broad  enough  at  the 
base  to  support  the  weight  of  the  body,  without  turning,  and  high 
enough  not  to  strain  the  muscles  of  the  leg.     A  lo\y  heel  is  best  for 
some  feet,  and  should  be  used  for  mountain  climbing. 

It  is  much  easier  to  buy  really  common-sense  shoes  today  than 
it  was  five  or  six  years  ago.  The  common-sense  shoes  of  that  day 
were  broad,  thick-soled,  low-heeled,  too  heavy  for  any  woman  to 


26  Personal  Hygiene  and  Home  Nursing 

wear,  unnecessarily  ugly ;  indeed,  a  type  of  shoe  that  no  one  ex- 
cept a  farm  laborer  would  need.  They  strained  the  muscles, 
blistered  the  feet,  and  were  anything  but  "  common  sense."  To- 
day the  demand  for  sensible  shoes  for  women  is  becoming  uni- 
versal, and  it  is  much  easier  to  buy  light-weight,  well-made,  good 
shoes. 


CHAPTER   FIVE 

FATIGUE  AND   HOW  TO   PREVENT  IT 

FATIGUE  is  physically,  intellectually,  and  morally  dangerous; 
and  if  we  shall  realize  this,  and  really  make  up  our  minds  to  pre- 
vent ourselves  from  becoming  overfatigued  and  to  do  the  things 
that  will  rest  us,  our  powers  of  accomplishment  will  be  increased. 
We  often  force  ourselves  to  go  on  when  we  are  not  doing  good  work 
and  not  securing  half  the  results  that  we  might,  simply  because 
we  have  not  the  good  judgment  to  stop  when  we  should.  A  few 
minutes  of  rest  taken  in  the  midst  of  work  may  mean  efficiency 
for  the  remainder  of  the  day.  There  are  times  in  every  one's 
life  when  it  is  necessary  to  draw  on  the  reserve  capital  of  nervous 
strength  which  nature  provides,  but  it  does  not  follow  that  this 
ought  to  be  an  everyday  procedure.  To  economize  on  rest,  sleep, 
and  fresh  air  is  to  be  penny  wise  and  pound  foolish.  In  modern 
studies  of  efficiency  it  has  been  found  that  more  work  is  often 
accomplished  by  shortening  the  hours  of  labor.  A  committee 
appointed  to  study  the  health  of  British  munition  workers  found 
that  the  hourly  output  of  100  women  who  were  making  fuses  in- 
creased 23  per  cent  when  the  weekly  hours  of  labor  were  shortened 
from  68.2  to  59.7,  and  the  hourly  output  of  27  men  at  heavy  work 
increased  24  per  cent  when  their  hours  were  reduced  from  61.5 
to  56.2  each  week. 

What  is  the  explanation  of  this?  In  all  that  we  do  either  con- 
sciously or  unconsciously  the  nervous  system  is  the  controlling 
power ;  it  not  only  directs  all  the  movements  of  the  muscles,  but 
it  also  regulates  the  heat  and  controls  the  secretions  of  the  body. 
The  cells  of  the  nervous  system  are  built  up  during  rest  and  sleep, 
and  it  is  necessary  that  the  body  should  be  rested  and  a  sufficient 
amount  of  sleep  taken  to  enable  the  nerve  cells  to  recuperate  from 
the  strain  which  is  constantly  put  upon  them.  The  effects  of 
fatigue  and  rest  are  shown  in  a  familiar  experiment  which  most 
students  of  physiology  are  taught  to  make. 

A  muscle  from  the  leg  of  a  frog  is  attached  by  one  end  to  the 

27 


Personal  Hygiene  and  Home  Nursing 


A 

.  i  ^jfjtjiiti&iii&tiiv*1^ 

<  •    ' 


FIG.  18.    A  tracing  made  by  the  contractions  of  a  muscle  from  a  frog's  leg.     As 
the  muscle  becomes  fatigued,  its  contractions  become  more  and  more  feeble. 

stationary  part  of  the  little  instrument  used  in  making  the  ex- 
periment. The  other  end  of  the  muscle  is  fastened  to  a  movable, 
sharp-pointed  arm  suspended  over  a  drum  covered  with  smoked 
paper.  Electricity  is  then  applied  to  the  muscle,  and  as  it  con- 
tracts from  the  stimulus,  the  pointed  arm  of  the  instrument  moves 
over  the  smoked  paper,  making  wavelike  lines,  the  height  of  each 
line  being  determined  by  the  strength  of  the  contraction  of  the 
muscle.  As  the  stimulation  continues  and  the  muscle  becomes 
exhausted,  the  contractions  become  more  and  more  feeble  and  the 
waves  lower  and  lower,  until  finally  the  instrument  moves  over 
the  paper  in  a  straight  line.  If  the  muscle  is  allowed  to  rest  and 
again  stimulated,  the  contractions  will  be  as  strong  as  they  were 
before  it  became  fatigued. 

Symptoms  of  fatigue.  When  fatigue  at  the  end  of  the  day  is 
too  great  to  be  repaired  by  a  night's  sleep,  and  we  wake  up  tired, 
something  is  wrong.  Danger  signals  which  it  is  well  to  note  are  : 
loss  of  appetite,  insomnia,  increase  of  fatigue  disproportionate  to 
output  of  work,  mental  depression,  lack  of  interest  in  the  work, 
lack  of  initiative,  loss  of  the  sense  of  proportion,  and  a  tendency 
to  worry.  Even  in  pleasures  it  is  possible  to  overwork  and  fatigue 
the  body.  To  spend  one's  leisure  rushing  from  one  recreation  to 
another,  without  taking  time  for  adequate  sleep  and  rest,  is  to 
hasten  the  time  when  amusements  will  no  longer  have  power  to 
amuse.  On  the  other  hand,  it  is  a  mistake  to  feel  that  one  must 
always  "  save  strength  "  for  the  day's  work,  for  many  times  an 


Fatigue  and  How  to  Prevent  It  29 

evening  at  the  theater  wakes  you  up,  lifts  you  out  of  the  rut,  and 
makes  life  seem  better  worth  living. 

Prevention  of  fatigue.  Attention  to  the  following  points  may 
prove  helpful  in  preventing  and  in  recovering  from  fatigue: 

(1)  Forgetting  work.    Learn  to  relax,  put  your  work  away  from 
you,  do  not  worry.     Most  people  who  work  seem  never  able  to 
get  away  from  it.     When  they  meet  they  talk  constantly  of  it, 
they  take  no  interest  in  anything  else,  and  so  they  are  never  rested 
from  it.     At  the  theater,  and  on  trains  or  boats,  how  many  times 
we  can  learn  exactly  what  occupations  the  people  who  are  around 
us  follow  without  becoming  acquainted  with  them.     Teachers  will 
talk  to  each  other  about  their  work,  and  business  men  about  their 
affairs.     The  minds  of  such  people  must  become  narrow  and 
fatigued. 

(2)  Suitable  exercise.     Combine  reasonable  physical  exercise  with 
mental  work.     If  very  much  fatigued  from  a  day's  work,  do  not 
overexercise.     For  instance,  a  teacher  who  has  been  standing  all 
day  is  not  benefited  by  taking  a  long  walk.     She  should  get  fresh 
air  by  taking  a  ride  in  an  open  car,  sleeping  out  of  doors,  or  by 
managing  in  some  way  to  spend   time  in  the  open  air  without 
fatigue. 

(3)  'Eating  regularly.    One  of  the  great  mistakes  that  women 
'sometimes  make  is  that  of  not  eating  regularly  and  properly. 

The  body  requires  food,  —  good  food  and  at  regular  intervals. 
When  shopping  or  when  engaged  in  any  other  matter,  however 
absorbing  it  may  be,  do  not  omit  a  regular  meal,  but  take  it  at  the 
hour  when  you  are  accustomed  to  taking  it. 

It  is  not  wise  to  eat  a  heavy  meal  when  you  are  overfatigued ; 
but  this  does  not  mean  going  entirely  without  food,  with  the  idea 
that  your  body  will  become  rested  and  then  you  can  eat.  It  is 
much  better,  if  you  have  been  several  hours  without  food,  to  take 
something  simple  like  a  glass  of  milk  or  buttermilk,  —  something 
that  is  easily  digested,  —  and  then  later  to  eat  the  meal.  One 
woman  I  knew  was  told  not  to  eat  when  she  was  fatigued.  She 


3O  Personal  Hygiene  and  Home  Nursing 

frequently  went  from  her  breakfast  of  one  day  to  the  breakfast 
of  the  next  day,  with  the  idea  that  she  was  carrying  out  the  doctor's 
orders.  She  never  found  herself  sufficiently  rested  to  eat  except 
in  the  morning  after  the  night's  sleep.  Needless  to  say,  she  was 
thin,  sick,  and  fatigued  all  the  time. 

One  of  the  important  medical  discoveries  of  recent  years  is  that 
many  persons,  both  children  and  adults,  are  thin  and  languid  and 
living  on  a  generally  low  physical  level  because  lack  of  appetite 
causes  them  to  take  insufficient  food.  The  body  requires  a  certain 
amount  of  food  to  give  it  vigor  and  strength,  and  when  meals  are 
missed  a  sufficient  supply  of  food  for  the  body's  needs  is  often  not 
taken. 

Interest  in  work.  Teach  yourself  to  like  your  work.  Put  your 
heart  into  it,  even  if  it  is  not  the  work  which  you  would  have 
selected  to  do.  It  is  remarkable  how  much  interest  one  can  take 
in  what  she  believes  is  uncongenial  work,  if  she  makes  up  her  mind 
to  like  it  and  puts  her  best  efforts  into  it.  Learn  to  work  cheer- 
fully ;  few  things  are  more  fatiguing  than  nagging  and  fussing,  or 
losing  the  temper.  Modern  psychology  teaches  that  the  mind 
does  not  tire  by  working  as  the  muscles  do,  but  that  mental  tasks 
become  distasteful  to  us  because  we  lose  interest  in  them.  "  We 
become  tired  of  work,  not  by  work."  Of  course,  this  statement 
does  not  take  account  of  the  cramping  of  the  body  from  staying  a* 
long  time  in  one  position,  of  the  eyes  becoming  tired,  or  of  other 
physical  exhaustion. 

Rest  and  sleep.  If  you  wish  to  keep  your  nerves  in  good  work- 
ing order,  you  must  have  plenty  of  sleep;  for  it  is  during  sleep 
that  the  cells  of  the  nervous  system  are  built  up  for  work.  The 
amount  of  sleep  necessary  varies  with  the  individual.  There  are 
a  very  few  who  seem  to  find  four  or  five  hours  of  sleep  enough ; 
most  persons  need  at  least  eight  hours'  sleep  to  keep  them  in  the 
best  of  health.  A  safe  general  rule  to  follow  is  to  make  sure  that 
you  are  getting  all  the  sleep  that  you  need.  Waking  up  sleepy 
and  tired  in  the  morning  is  a  pretty  sure  indication  of  a  lack  of 


Fatigue  and  How  to  Prevent  It  31 

sleep  or  of  a  diseased  condition  of  the  body  that  is  causing  un- 
natural drowsiness  and  needs  medical  attention.  A  wise  division 
of  the  day  for  most  persons  is  eight  hours  for  sleep,  eight  hours  for 
work,  and  eight  hours  for  recreation  and  attending  to  the  ordinary 
routine  affairs  of  life. 

Fresh  air.  Many  persons  have  reported  that  they  require  fewer 
hours  of  sleep  when  they  spend  their  nights  in  the  open  air,  and 
unquestionably  fresh  air  is  good  for  tired  nerves.  When  sleeping 
out  of  doors  one  may  use  a  sleeping  bag  to  help  preserve  the  body 
heat.  This  may  be  of  any  thickness  suitable  to  the  wearer,  and 
can  be  washed  when  necessary.  Flannelette  blankets  which  can 
be  easily  washed  may  be  used  instead  of  sheets,  and  a  warm  gown 
or  wrapper  should  be  worn.  Bedclothes  that  are  too  heavy  are 
fatiguing ;  it  is  much  better  to  provide  woolen  blankets  and  light- 
weight comfortables.  In  bitter  weather  it  is  best  to  cover  the 
head  and  ears  with  a  hood.  This  hood  can  be  made  with  an 
opening  in  front  for  the  face,  and  a  cape  to  cover  the  neck  and 
throat.  Persons  who  are  not  in  vigorous  health  may  find  it  ad- 
visable to  wear  thick  stockings  or  bedroom  slippers  when  sleeping 
outdoors  in  very  severe  weather.  A  warm  sleeping  garment  of 
some  kind  should  be  used  to  prevent  direct  contact  with  the  cold 
bed  and  to  break  draughts  of  air  that  may  penetrate  between  the 
covers  and  the  skin.  The  bed  and  bedclothes  should  be  of  ample 
length  or  the  feet  will  be  cold.  It  is  always  to  be  remembered 
that  if  outdoor  sleeping  is  to  be  beneficial,  the  sleeper  must  be  com- 
fortable. A  restless  night  out  of  doors  is  much  less  refreshing  than 
a  night  of  comfortable  sleep  indoors. 

If  outdoor  sleeping  is  not  practiced,  one  should  at  least  have 
plenty  of  fresh  air  in  the  sleeping  room.  See  that  there  is  plenty 
of  covering  for  the  body,  particularly  for  the  feet ;  then  open  the 
windows  and  let  in  all  the  air  possible.  If  you  cannot  stand  a 
direct  draught,  place  a  screen  between  the  bed  and  the  window, 
or  drape  something  across  the  bed,  like  a  shawl  or  sheet  to  hang 
between  you  and  the  window.  Turn  off  all  artificial  heat.  In  a 


32  Personal  Hygiene  and  Home  Nursing 

house  heated  by  a  hot-air  furnace,  there  is  always  danger  of  the 
escape  of  gas ;  and,  in  any  case,  it  is  not  healthful  or  restful  to  sleep 
with  artificial  heat  in  the  room.  The  best-ventilated  room  is 
the  one  in  which  the  air  has  the  right  amount  of  moisture  in  it  and 
is  cool  and  in  motion.  The  motion  of  the  air  is  more  important 
than  the  proportion  of  oxygen  and  carbon  dioxid  it  contains. 

The  ventilation  of  workrooms  also  needs  attention,  for  working 
in  a  close  atmosphere  is  very  exhausting  and  those  who  are  com- 
pelled to  labor  in  unventilated  rooms  often  become  tired  and 
irritable.  Those  who  insist  upon  excluding  fresh  air  from  an 
office  or  workroom  are  often  very  selfish  in  preventing  others  from 
having  fresh  air.  Teach  yourself  to  like  it,  for  it  is  beneficial  to 
you;  and  remember  that  those  who  are  accustomed  to  working 
in  a  well- ventilated  room  are  greatly  inconvenienced  and  even  made 
sick  by  a  close  room. 


CHAPTER   SIX 
HYGIENE  OF  THE  MENSES 

NOTHING  in  a  woman's  life  is  more  important  to  her  health,  her 
mental  capacity,  and  her  powers  of  accomplishment  than  her 
condition  each  month  during  the  menses,  or  monthly  period. 
We  are  told  by  the  doctors  and  by  medical  books  that  this  is  a- 
perfectly  normal  function,  and  that  the  healthy  woman  should 
feel  no  pain  and  but  little  discomfort  from  it.  However  that 
may  be,  we  all  know  that  there  are  few  women  who  are  not  some- 
what below  par  at  this  time.  It  seems  to  a  girl  terribly  hard  to 
think  of  looking  forward  to  this  strain  on  her  system,  every  month, 
and  unfortunately  most  girls  'are  so  young  when  they  first  en- 
counter this  new  condition  in  life,  that  they  have  no  judgment  to 
tell  them  what  they  ought  to  do.  They  disregard  warnings,  and 
do  ignorant  or  foolish  things  which  cause  them  to  suffer  for  years 
afterward.  If  they  only  understood  how  important  the  matter 
of  taking  proper  care  of  oneself  at  this  time  really  is,  and  how 
serious  the  consequences  of  neglect  may  be,  they  would  not  think 
of  taking  the  risks  that  in  too  many  cases  they  do  take. 

Age  when  the  menses  begin  and  cease.  The  monthly  period 
usually  begins  between  the  ages  of  twelve  and  fifteen  or  sixteen, 
although  in  some  cases  it  may  come  on  much  earlier  and  in  some 
cases  later.  If  its  appearance  is  delayed  beyond  this  age,  it  is 
best  to  put  the  girl  under  the  care  of  a  good  physician  so1  that  he 
may  watch  for  adverse  symptoms  and  use  such  means  as  he  con- 
siders necessary  to  bring  the  period  on.  No  one  except  a  good 
physician  should  prescribe  for  this  condition,  for  medicines  given 
by  some  one  who  has  not  made  a  thorough  study  of  this  subject 
may  cause  a  condition  of  congestion  that  will  bring  months  of 
suffering.  There  is  no  rule  about  the  exact  age  at  which  the 
menstrual  flow  will  cease,  except  that  the  cessation  of  the  menses, 
or  "  change  of  life,"  usually  takes  place  between  forty-five  and  fifty. 

Regularity  in  menstruation.  The  normal  flow  returns  once  in 
every  twenty-eight  days  and  lasts  from  three  to  five  or  six  days. 

33 


34  Personal  Hygiene  and  Home  Nursing 

As  in  the  case  of  the  age  of  beginning  and  ending,  this  varies  with 
the  individual,  so  that  no  law  can  be  stated.  Each  woman  is  a 
law  to  herself  in  this.  It  may  come  once  in  five  or  six  weeks. 
I  have  known  cases  where  it  has  been  once  in  two  months  and  the 
health  was  apparently  normal.  The  only  rule  that  can  be  given 
is,  that  each  woman's  regularity  becomes  established,  and  any 
variation  from  this  in  her  case  would  be  abnormal.  If  she  has 
always  menstruated  once  in  five  weeks  and  the  periods  become 
longer  or  shorter,  her  condition  is  abnormal,  though  the  change 
may  or  may  not  be  of  importance. 

Sometimes  when  menstruation  begins  early,  it  will  come  with 
more  frequency  and  greater  flow,  and  later  in  the  development  of 
the  girl  she  may  establish  a  different  order,  the  period  returning 
at  longer  intervals  and  the  flow  decreasing  in  quantity.  With 
some  women  the  period  may  last  as  long  as  eight  days.  This  is 
rather  abnormal  and  sometimes  indicates  a  general  run-down  con- 
dition. With  the  building  up  of  the  general  health,  this  time  may 
be  shortened. 

Occasionally  the  period  may  stop  entirely.  This  is  always  true 
during  pregnancy,  often  during  typhoid  fever,  tuberculosis,  and 
other  wasting  diseases.  A  complete  change  of  climate  or  of  occu- 
pation may  cause  a  temporary  stoppage.  For  instance,  among 
nurses  training  in  hospitals  many  cases  have  been  known  of  the 
menses  stopping  for  from  three  months  to  a  year,  with  no  con- 
stitutional effect.  Girls  going  from  one  part  of  the  country  to 
another  to  attend  school,  and  taking  up  arduous  school  duties, 
frequently  miss  several  months.  Such  girls  should  be  in  the  care 
of  an  experienced  woman,  and  if  the  condition  continues  into  two 
or  three  months  it  is  best  to  report  the  matter  to  a  physician,  that 
he  may  note  any  adverse  symptoms.  Nevertheless,  most  physi- 
cians will  do  nothing  to  bring  on  menstruation,  as  they  recognize 
that  it  should  be  a  natural  condition  of  the  body.  Should  there 
be  headache  or  intense  nervousness,  —  not  merely  nervous  fear 
because  the  regularity  of  the  menses  has  been  interrupted,  — 


Hygiene  of  the  Menses  35 

bloating  of  the  body,  or  other  symptoms,  then  the  physician  will 
take  measures  to  remedy  these  conditions. 

Frequent  causes  of  pain  at  the  menstrual  period.  Pain  at  the 
menstrual  period  does  not  always  indicate  inflammation  of  the 
uterus.  It  may  have  any  one  of  several  reasons,  and  the  last 
thing  to  be  done  in  relieving  it  is  the  treatment  of  the  uterus 
itself.  The  uterus  lies  in  the  body  between  the  bladder  and 
part  of  the  large  intestine.  Because  of  the  positions  of  the 
large  intestine  and  the  uterus,  pain  in  one  is  often  mistaken 
for  pain  in  the  other.  More  than  one  case  of  so-called  inflam- 
mation of  the  uterus  has  been  found  to  be  inflammation  of  the 
descending  colon,  and  the  trouble  has  been  relieved  by  treat- 
ment of  the  intestine.  Sometimes  clearing  out  the  bowels  with 
an  enema,  or  loosening  the  clothes,  is  all  that  is  necessary  to 
relieve  pain. 

At  the  time  and  shortly  before  the  coming  of  the  menses  the 
uterus  becomes  slightly  swelled  or  congested,  and  if  the  lower 
intestine  is  filled  with  waste  matter  there  is  a  pressure  on  this 
organ.  This  is  one  of  the  most  frequent  causes  of  pain  during 
the  period.  For  this  reason,  if  for  no  other,  the  bowels  should 
be  emptied  each  day.  Leaving  the  bowels  full,  to  press  against 
the  uterus,  is  one  of  the  most  common  causes  of  the  falling  down 
or  misplacement  of  the  uterus.  Clothing  should  not  be  worn 
tight  around  the  waist,  because  it  presses  the  organs  downward, 
and  tends  to  cause  the  same  trouble.  Pain  during  the  period  may 
be  an  indication  of  a  run-down  condition  rather  than  of  local  in- 
flammation. Many  cases  of  so-called  female  trouble  have  been 
relieved  by  a  good  tonic,  fresh  air,  rest,  and  a  general  building  up 
of  the  body.  If  a  girl  suffers  at  this  time,  every  attention  should 
be  paid  to  her  general  condition  and  health.  Exercise  tending 
to  improve  the  general  health  is  a  good  thing  always,  and  especially 
in  cases  of  this  trouble.  Generally  speaking,  varied  occupation  is 
better  than  sitting  still  at  this  time.  To  be  on  one's  feet  all  day, 
or  to  be  obliged  to  sit  or  stand  in  one  position  for  many  hours,  will 


36  Personal  Hygiene  and  Home  Nursing 

sometimes  cause  pain  when  moderate  exercise  and  some  rest  would 
not. 

Work  during  the  menstrual  period.  One  of  the  first  questions 
asked  is  always :  Should  I  go  to  bed  for  a  day  or  two  during  this 
time?  If  a  girl  is  delicate,  either  from  abnormal  constitutional 
conditions  or  from  some  inflammation,  it  is  necessary  to  give  up 
and  go  to  bed  for  a  day  or  two.  But  the  normal  girl  will  find  it 
unwise  and  unnecessary  to  cultivate  the  habit  of  giving  up  en- 
tirely each  month.  If  she  continues  to  follow  her  usual  habits 
of  life  as  far  as  possible,  she  will  find  that  she  can  form  the  habit 
of  doing  whatever  must  be  done,  without  any  ill  results.  We  are 
creatures  of  habit,  and  to  form  the  habit  of  giving  up  all  active 
life  for  a  day  or  two  each  month  means  that  after  a  while  the  body 
will  be  quite  unable  to  respond  to  any  demand  at  this  time.  There 
are  few  positions  in  life  which  a  woman  can  fill  capably  if  she 
must  give  up  one  working  day  each  month  to  complete  rest ;  for 
she  could  not  depend  upon  herself  and  no  one  else  could  depend 
upon  her  for  any  real  work  in  the  world. 

Overwork  to  be  avoided.  In  many  cases  there  is  an  influx  of 
nervous  energy  before  or  during  the  first  part  of  the  period,  which 
drives  the  woman  to  exert  herself  beyond  her  strength.  She  must 
clean  house,  finish  a  dress,  attend  to  a  dozen  undone  tasks  which 
all  of  a  sudden  seem  of  the  utmost  importance;  and  when  the 
period  really  comes  on  she  pays  for  all  this  activity  by  fatigue  and 
pain.  This  restless  energy  is  only  a  form  of  nervousness  and 
should  be  recognized  as  such.  All  necessary  work  should  be  done, 
but  unnecessary  work  or  excessive  exercise  should  be  avoided. 
A  woman  who  is  accustomed  to  walking  should  take  the  car  at 
this  time  if  walking  tires  her.  Gymnasium  work  should  be  dis- 
continued for  the  same  reasons,  unless  you  are  an  instructor  in 
a  gymnasium.  Even  then  try  to  do  as  little  of  it  as  possible. 

Bathing  during  the  period.  The  body  must  of  course  be  kept 
clean,  but  bathing  should  be  done  with  judgment.  A  warm  sponge 
bath  may  be  taken  daily.  A  warm  tub  bath  is  not  necessarily 


Hygiene  of  the  Menses  37 

injurious,  although  if  the  body  shrinks  from  the  bath  it  should  not 
be  taken.  Hot  baths  increase  the  flow  and  should  not  be  taken 
unless  needed..  Cold  baths  should  never  be  taken,  as  they  check 
the  flow ;  and  a  girl  should  not  go  in  swimming  until  the  period 
is  quite  over. 

Wet  shoes  and  chilling  the  body.  Getting  the  feet  wet  is  in- 
jurious, but  the  danger  is  averted  if  the  wet  shoes  and  stockings 
are  immediately  changed  for  dry  ones.  If,  owing  to  circumstances, 
this  is  impossible,  —  as  in  case  of  getting  caught  in  a  storm,  — 
keep  on  walking  until  the  shoes  can  be  changed,  but  do  not  sit 
still  in  wet  garments.  If  the  feet  become  chilled,  take,  as  soon 
as  possible,  a  hot  foot  bath.  Put  a  little  mustard  in  the  water 
and  soak  the  feet  in  it.  Hot  tea  and  toast  or  some  other  hot 
stimulant  will  sometimes  promote  digestion  and  ward  off  a  chill. 
It  is  not  wise  to  take  ice  cream  and  cold  drinks  at  this  time,  except 
in  moderation,  because  they  chill  the  stomach.  Indigestible  food 
should  be  avoided,  as  an  accumulation  of  gas  in  the  intestines  will 
cause  pain.  The  general  rule  for  health  as  well  as  comfort  at  this 
time  is,  —  keep  dry,  warm,  and  properly  fed,  and  do  not  get  over- 
tired. Lack  of  suitable  food  or  clothing,  or  exposure  to  cold,  may 
induce  a  chilled  condition,  which  is  harmful. 

Medicine  during  the  menstrual  period.  No  girl  should  take 
medicine  or  use  any  means  to  bring  on  or  check  the  flow  of  blood. 
If  she  does  this,  she  is  running  a  great  risk  of  causing  acute  in- 
flammation of  the  uterus  and  its  appendages.  I  have  been  ap- 
palled by  the  number  and  kinds  of  medicines  passed  from  girl  to 
girl  among  schoolgirls.  This  should  never  happen.  Few  girls 
know  the  exact  effect  of  a  medicine,  and  the  fact  that  a  prescription 
is  given  to  one  girl  in  a  certain  condition  is  no  indication  whatever 
that  another  girl  apparently  suffering  from  the  same  ailment  needs 
that  medicine.  A  physician,  in  giving  a  prescription,  considers 
not  only  the  symptoms  detailed  to  him,  but  the  constitution  of 
the  patient,  so  far  as  he  can  judge  of  it,  and  he  also  forms  his  private 
opinion  of  the  condition  of  the  patient  at  the  time  and  tries  to 


38  Personal  Hygiene  and  Home  Nursing 

make  his  prescription  suitable  to  her  special  case.  Strong  cathar- 
tics should  not  be  taken  during  the  period,  as  they  increase  the 
flow  and  often  cause  pain  and  weakness.  Apart  from  all  these 
considerations,  there  is  great  danger  that  an  unauthorized  pre- 
scription may  contain  some  opiate  or  drug  which  no  reputable 
physician  would  prescribe. 

The  menopause  or  "  change  of  life."  The  menopause  or  period 
during  which  there  is  a  final  cessation  in  the  menstrual  life  of  a 
woman  occurs  generally  between  the  ages  of  forty-five  and  fifty. 
There  are  many  exceptions  to  this  rule,  some  women  not  menstruat- 
ing after  forty  and  some  continuing  menstruation  until  after  fifty 
years  of  age.  During  the  menopause  only  one  period  may  be 
missed  at  first,  or  several  months  may  pass  without  an  appearance 
of  the  menses.  After  this  interruption  the  periods  may  reappear 
and  continue,  regularly  for  a  while,  the  flow  becoming  gradually  less 
profuse  until  it  stops  entirely.  With  some  women  it  stops  abruptly 
without  premonitory  symptoms  and  never  reappears. 

There  is,  no  doubt,  a  tendency  to  disease  at  this  time,  but  a 
woman  should  pass  through  these  months  without  serious  com- 
plications. Headache,  digestive  disturbances,  and  many  nervous 
conditions,  such  as  a  disagreeable  sensation  of  heat  which  rushes 
over  the  body  at  times,  and  which  is  usually  spoken  of  as  "  flushes," 
are  as  a  rule  present.  A  woman  may  suffer  also  from  insomnia 
and  may  become  irritable  and  sometimes  melancholy.  However, 
the  custom  of  attributing  all  unusual  symptoms  which  may  develop 
in  a  woman  between  the  ages  of  forty  and  fifty  to  "  change  of  life  " 
has  at  times  resulted  in  a  failure  to  give  the  thorough  examination 
which  should  have  been  given  to  determine  the  real  condition 
present,  of  which  the  symptoms  were  an  indication. 

The  belief  that  is  so  universal  among  women,  that  they  cannot 
pass  through  these  months  without  ill  health,  is  one  reason  for 
their  nervous  condition  at  this  time.  If  a  woman  is  healthy  before 
the  menopause  begins,  she  should  be  able  to  pass  through  the  period 
with  very  little  discomfort.  At  the  same  time  she  should  do  all 


Hygiene  of  the  Menses  39 

that  she  can  do  to  keep  herself  in  good  health.  She  should  be  out 
of  doors  as  much  as  possible,  taking  exercise  enough  to  keep  her- 
self in  good  condition  but  not  enough  to  overtire  her.  Her  diet 
should  be  simple  and  consist  only  of  food  that  she  can  easily  digest. 
She  should  not  eat  meat  to  excess  nor  drink  too  much  coffee  or 
tea,  and  should  avoid  all  stimulating  drinks.  The  bowels  should 
be  kept  open  regularly,  and  an  occasional  dose  of  sal  hepatica  or 
some  similar  salts  may  be  taken  to  help  relieve  headache  and 
prevent  "  flushes."  Necessary  rest  should  be  taken  through  the 
day,  and  extremely  late  hours,  excitement,  and  worry  avoided  as 
much  as  possible. 

Dangerous  symptoms.  There  are  certain  symptoms  that  may 
appear  during  the  menopause  that  are  an  indication  of  an  abnormal 
condition,  and  if  they  should  be  present,  a  physician  should  be 
consulted  at  once.  These  symptoms  are:  (i)  a  profuse  bleeding 
at  the  time  of  a  period,  (2)  bleeding  between  the  periods,  (3)  the 
reappearance  of  the  flow  of  blood  some  months  after  menstruation 
has  stopped.  Any  one  of.  these  symptoms  may  be  an  indication 
of  some  condition  which  can  be  relieved  by  a  simple  operation  or 
(and  this  is  most  often  the  case)  may  show  that  there  is  either  a 
tumor  within  the  uterus  or  be  the  first  symptoms  of  cancer.  Since 
the  only  cure  at  present  known  for  cancer  is  to  remove  the  affected 
part,  and  since  the  disease  is  curable  only  if  this  can  be  done  in 
the  early  stages  while  the  condition  is  merely  a  local  one,  a  physician 
should  be  consulted  at  the  first  appearance  of  any  of  these 
symptoms.  Any  delay  in  this  may  allow  time  for  the  disease  to 
spread  and  make  it  impossible  to  cure  by  operation  or  in  any  other 
way. 

Cancer  in  women  occurs  frequently  in  the  breast  also,  and  upon 
the  appearance  of  a  lump  in  the  breast  the  advice  of  a  surgeon  should 
be  asked  at  once.  It  is  considered  best  in  these  days  to  remove  a 
growth  of  this  kind  before  it  can  become  malignant.  A  small  lump 
may  be  present  in  the  breast  for  some  time  and  be  to  all  appearance 
harmless,  but  at  the  time  of  the  menopause  or  at  some  other  time 


4O  Personal  Hygiene  and  Home  Nursing 

it  may  suddenly  begin  to  enlarge  and  develop  into  a  cancerous 
growth.  Many  women  conceal  such  a  condition  until  the  tumor 
has  reached  such  size  or  become  so  malignant  that  the  operation 
for  its  removal  has  become  a  serious  one  instead  of  the  slight  one 
which  would  have  been  all  that  was  necessary  at  first,  or  until  the 
disease  has  so  spread  throughout  the  system  that  it  cannot  be 
checked  even  by  a  serious  operation.  The  one  safe  rule  when  a 
growth  appears  anywhere  in  the  body  is  to  consult  a  physician 
or  surgeon  at  once. 


CHAPTER   SEVEN 
CONSTIPATION 

THERE  are  few  abnormal  conditions  of  the  body  more  common, 
more  the  fault  of  the  individual,  and  more  serious  in  the  effects 
upon  the  health,  than  chronic  constipation.  Most  persons  fail 
to  consult  a  physician  for  the  trouble  until  they  have  tried  various 
kinds  of  remedies,  and  in  many  families  or  groups  of  persons  a 
favorite  remedy  is  passed  around  from  one  to  another.  The 
remedy  too  often  is  some  patent  medicine,  made  famous  by  ad- 
vertising, of  which  neither  the  ingredients  nor  the  effects  are 
accurately  known  to  the  user.  Such  remedies  give  only  temporary 
relief.  They  not  only  do  not  cure  the  disease,  but  often  injure 
the  intestines.  Moreover,  as  in  all  cases  where  a  remedy  found 
beneficial  by  one  person  is  passed  on  to  another,  the  difference 
in  constitution  may  be  such  that  the  medicine  will  be  positively 
harmful. 

Causes  of  constipation.  Certain  habits  predispose  to  this 
trouble  in  women.  The  sedentary  life  which  they  often  lead  makes 
them  suffer  from  it  more  than  men.  Irregularity  of  habits,  weak- 
ness of  the  abdominal  muscles,  and  unwise  methods  of  dressing 
also  tend  to  increase  constipation  in  women.  The  old  are  likely 
to  be  constipated  because  of  their  lower  vitality,  weakness  of  the 
muscles  in  the  abdomen  and  intestinal  walls,  lack  of  exercise,  and 
the  small  amount  of  food  they  take. 

Constipation  is  sometimes  caused  by  the  fact  that  the  stomach 
and  intestines  have  sagged  down  out  of  place.  Normally  the 
stomach  lies  up  close  to  the  angle  formed  by  the  ribs  and  more  to 
the  left  side  of  the  body  than  to  the  right.  The  large  intestine, 
or  colon,  in  which  the  waste  matter  from  food  is  .stored,  begins 
on  the  right  side  of  the  abdomen,  where  the  appendix  is,  and 
extends  up  the  right  side  to  a  point  under  the  liver  where  it  is 
attached  to  the  rear  wall  of  the  abdominal  cavity  by  ligaments. 
After  making  a  bend  it  crosses  the  abdomen  just  below  the  stomach 
and  well  above  the  umbilicus  (navel)  and  is  attached  by  ligaments 

41 


Personal  Hygiene  and  Home  Nursing 


Dr.  A.  P.  Evans 

FIG.  ig.  Radiograph  showing  position  of  large  intestine.  The  transverse  colon 
which  should  run  across  the  upper  part  of  the  abdominal  cavity  has  sagged  down 
until  at  a  it  lies  within  the  pelvic  cavity.  At  b  the  descending  colon  is  kinked  sharply 
and  is  adherent  to  the  transverse  colon. 

to  the  left  wall  of  the  abdominal  cavity.  Then  it  bends  again  and 
goes  down  the  left  side  of  the  abdomen  to  the  rectum.  The 


Constipation  43 

rectum  is  S-shaped,  having  folds  and  pockets  which  hold  the  sub- 
stance deposited  in  them. 

When  the  stomach  and  intestine  are  held  in  place,  the  feces 
(waste  matter  of  the  bowels)  can  pass  through  the  turns  in  the 
intestine ;  but  when  for  any  reason  they  sink  out  of  place  and  the 
bends  in  the  intestine  are  intensified,  it  becomes  difficult  for  the 
feces  to  pass  through  the  intestine.  A  condition  of  constipation 
then  follows. 

A  diagnosis  of  this  condition  can  often  be  made  by  examination 
of  the  general  posture  and  shape  of  the  abdomen,  but  such  a 
diagnosis  should  be  verified  by  an  X-ray  examination  of  the  con- 
tents of  the  abdomen.  All  such  cases  are  benefited  by  special 
exercises,  but  should  be  treated  only  under  the  care  of  a  physician. 

The  principal  cause  of  constipation,  however,  in  old  or  young, 
men  or  women,  is  lack  of  regularity  in  evacuation.  Normally 
the  bowels  should  move  once  or  twice  each  day,  and  if,  beginning 
in  childhood  and  continuing  through  life,  this  matter  were  at- 
tended to  regularly  each  day  by  every  one,  there  would  be  fewer 
cases  of  constipation.  The  right  time  for  an  evacuation  is  soon 
after  eating.  When  food  enters  the  stomach  it  induces  peristalsis, 
a  wavelike  movement  which  passes  over  the  intestine  toward  the 
rectum.  It  is  much  easier,  therefore,  to  cause  the  bowels  to 
empty  soon  after  eating. 

The  habit  of  taking  cathartics  and  enemas  is  a  frequent  cause  of 
constipation.  Other  causes  are  improper  diet  and  lack  of  exercise. 

Consequences  of  constipation.  Among  the  consequences  of 
constipation  are  headache,  sleepiness,  bad  dreams,  dullness,  indi- 
gestion of  all  varieties,  irritability,  nervousness,  bad  taste  in  the 
mouth,  foul  breath,  nausea,  excessive  thirst,  flatulency,  colic, 
cold  extremities,  a  frequent  desire  to  urinate,  sallow  complexion, 
pimples  on  the  face  and  liability  to  colds  and  hemorrhoids  or  piles. 
These  last  are  a  swelled  condition  of  the  veins  in  the  lower  intestine 
or  rectum.  They  are  caused  by  the  pressure  of  hard  masses  of 
feces  retained  in  the  rectum  when  the  bowels  are  in  a  constipated 


44  Personal  Hygiene  and  Home  Nursing 

condition,  and  by  straining  during  the  passage  of  large  masses  of 
feces  during  evacuations  from  the  bowels.  One  should  always 
be  careful  not  to  strain  when  having  an  evacuation. 

Hemorrhoids  at  times  become  very  painful  and  bleed,  and  by 
their  intense  itching  and  soreness  they  cause  insomnia,  nervous- 
ness, and.  irritability.  They  should  not  be  neglected,  but  should 
be  treated  at  their  first  appearance,  for  they  may  become  so  bad 
that  an  operation  will  be  necessary.  Sponging  with  cold  water 
or  witch  hazel  helps  to  relieve  the  itching  and  soreness,  and  ad- 
renalin salve  and  suppositories  reduce  the  swelling  and  will  some- 
times cure  quite  bad  cases  of  hemorrhoids.  If  suppositories  of 
cocoa  butter  or  gluten  are  inserted  at  night  and  left  to  lubricate 
the  lower  bowel,  the  danger  of  irritating  the  rectum  at  the  morn- 
ing's evacuation  is  much  lessened.  There  are  many  salves  sold 
for  the  relief  of  hemorrhoids.  Of  these  the  best  are  Unguentine 
and  a  witch-hazel  salve. 

— _  j 

Symptoms  of  constipation.  The  usual  test  for  the  condition  of 
the  bowels  is  the  number  of  evacuations  daily  or  weekly.  Most 
persons  consider  one  or  two  movements  a  day  absolutely  neces- 
sary, others  think  five  or  six  a  week  a  normal  condition.  This 
is,  however,  not  the  sole  point  to  be  considered.  Symptoms  may 
exist  indicating  a  state  of  constipation  even  when  there  are  daily 
evacuations.  The  daily  movement  may  not  empty  the  bowels, 
but  may  leave  hard,  dry  feces  clinging  to  the  walls  of  the  large 
intestine.  There  may  also  be  what  is  called  "  latent  constipation  "  ; 
that  is,  the  movement  of  today  may  not  bring  away  the  waste 
of  yesterday,  but  that  of  two  or  three  days  before.  One  indica- 
tion of  these  two  conditions  is  the  passage  of  hard,  round  lumps. 
Another  is  an  occasional  attack  of  diarrhea.  Sometimes,  in  the 
midst  of  these  soft  or  fluid  movements,  small,  hard  lumps  will  be 
passed.  The  symptoms  already  noted  as  consequences  of  con- 
stipation should  also  be  taken  into  account.  With  any  of  these 
conditions  present,  a  state  of  constipation  may  be  said  to  exist. 
~  Difficulty  of  curing  constipation.  For  several  reasons  constipa- 


Constipation  45 

tion  is  oftentimes  hard  to  cure.  First,  the  absolute  cooperation 
of  the  patient  is  frequently  difficult  to  obtain.  Owing  to  this, 
a  physician,  becoming  aware  that  his  directions  will  not  be  fol- 
lowed exactly,  may  prescribe  for  daily  use  some  medicine  which 
he  knows  will  not  injure  the  patient.  If  he  cannot  effect  a  com- 
plete cure,  he  prefers  to  do  what  he  can  to  reduce  the  ill  effects 
.of  the  disease. 

A  second  difficulty  is  that  the  patient  does  not  always  under- 
stand the  length  of  time  needed  for  a  cure,  and  thus  becomes 
impatient  and  loses  confidence  in  the  physician.  The  walls  of 
the  intestine  are  muscular,  and  in  a  case  of  constipation  of  long 
standing  these  muscles  become  weak  and  sluggish.  A  systematic, 
long-continued  treatment  is  then  indispensable  if  a  cure  is  to  be 
effected.  The  fact  that  in  most  cases  cathartics  have  been  taken 
may  make  it  difficult  to  find  a  medicine  that  will  relieve,  even  tem- 
porarily. But  almost  all  cases  of  constipation,  even  those  of  many 
years'  standing,  will  be  greatly  benefited,  if  not  cured,  by  consist- 
ent and  conscientious  cooperation  between  physician  and  patient. 

Curing  mild  cases  of  constipation.  The  habit  of  going  to  the 
toilet  at  a  certain  hour  each  day  is  frequently  all  that  is  needed 
to  correct  a  mild  case  of  constipation.  This  should  be  done  whether 
the  bowels  are  moved  or  not ;  the  important  thing  is  to  choose  a 
certain  hour  and  form  the  habit  of  going  to  the  toilet  at  that  time. 
If  it  is  impossible  to  take  the  time  for  this  immediately  after 
breakfast,  as  in  the  case  of  those  who  leave  the  house  at  once  to 
go  to  their  work,  some  other  hour  may  be  selected.  Those  who 
must  go  out  early  can  train  themselves  to  go  to  the  toilet  immedi- 
ately after  rising,  if  they  will  start  peristalsis  by  drinking  a  glass 
of  water.  An  abundance  of  water  should  be  taken  at  night,  before 
breakfast,  and  frequently  through  the  day. 

Diet  for  constipation.  The  proper  regulation  of  the  diet  will 
cure  some  cases  of  constipation,  and  be  beneficial  in  any  case. 
To  obtain  the  best  results  the  diet  should  be  well  balanced  and 
should  contain  six  times  as  much  vegetable  matter  as  it  does 


46  Personal  Hygiene  and  Home  Nursing 

meat;  it  should  also  contain  oil,  sugar,  an  abundance  of  water, 
and  some  starch.  Dietary  changes  should  be  made  carefully,  and 
foods  which  cannot  be  properly  digested  should  be  left  out.  Some- 
times adding  to  the  bill  of  fare  one  or  two  articles  having  a  laxative 
effect  and  dropping  some  one  food  of  constipating  tendency  will 
be  all  that  is  necessary  to  relieve  a  slight  attack  of  constipation. 

Foods  allowed.  Cereals:  Oatmeal,  cornmeal  mush,  cracked 
wheat,  hominy,  grits,  cream  of  wheat. 

Soups :    Any  soup  except  thick  broths. 

Fish :     Fresh  fish  of  all  kinds,  oysters  (not  fried). 

Meat :  Bacon,  beef,  mutton,  lamb,  chicken,  poultry  in  general, 
squabs,  game,  sweetbreads. 

Bread :  Brown,  graham,  whole-wheat,  corn  bread,  bran,  and 
rye  bread.  (No  toast.) 

Oleaginous  foods :     Cream,  bone  marrow,  oils,  and  butter. 

Salads:  Vegetable  and  fruit  salads  with  plenty  of  good  olive 
oil. 

Vegetables :  Carrots,  turnips,  onions,  beets,  cauliflower,  spinach, 
cress,  celery,  peas,  string  beans,  corn,  tomatoes,  potatoes, 
cabbage,  squash,  lettuce,  cucumbers,  asparagus,  and  other 
vegetables  having  in  them  large  quantities  of  bulky  fiber. 

Desserts  and  sweets :  Sugar,  candy  in  moderation,  honey, 
sirup,  molasses,  jellies,  jams,  baked  apples;  bread,  apple, 
fig,  and  prune  puddings ;  custards  and  ice  cream. 

Fruit  and  berries :  All  except  bananas,  blueberries,  and  black- 
berries. 

Drinks:  Buttermilk,  malted  milk,  milk  (not  boiled).  Coffee 
is  laxative  to  some  people. 

Figs  are  beneficial  if  taken  at  any  hour,  but  dates  and  prunes 
eaten  at  night  before  retiring  will  help  to  give  a  movement  from 
the  bowels  in  the  morning. 

Foods  prohibited.  Meats  to  excess,  pork,  liver,  salted,  canned, 
or  smoked  meats,  too  many  eggs,  boiled  milk,  or  an  excessive 


Constipation  47 

amount  of  milk,  cocoa,  and  chocolate,  rice  to  excess,  farina, 
gruels,  macaroni,  thick  broths,  tea,  cheese,  nuts,  blueberries, 
huckleberries,  and  blackberries. 
Doughnuts,  pies,  crackers,  and  cakes. 

Massage  and  exercises.  In  cases  of  constipation  massage  is 
of  great  benefit  when  properly  given,  as  it  strengthens  the  ab- 
dominal muscles  and  stimulates  the  muscles  of  the  intestine. 
A  five-pound  cannon  ball  or  a  bowling  ball  may  be  rolled  over 
the  abdomen  with  benefit.  These  balls  can  be  bought  at  any 
store  selling  gymnasium  apparatus.  The  ball  should  be  rolled  over 
the  large  intestine ;  that  is,  up  the  right  side,  across  the  top  of 
the  abdomen,  and  down  the  left  side.  The  abdominal  muscles 
should  be  relaxed,  and  the  best  position  of  the  body  to  obtain  this 
relaxation  is  lying  on  the  back,  with  the  head  and  shoulders  moder- 
ately high  and  the  knees  flexed. 

Walking,  running,  horseback  riding,  rowing,  swimming,  and 
all  such  games  as  tennis  and  baseball  tend  to  strengthen  the 
abdominal  muscles  and  to  increase  the  tone  of  the  nerve 
centers  that  regulate  the  liver  and  intestines  and  assist  the 
circulation  of  blood  through  these  organs.  The  practice  of 
taking  a  few  special  exercises  daily  is  a  good  one  to  establish, 
as  help  can  be  derived  in  this  way,  but  these  exercises  should 
be  prescribed  by  a  physician  or  some  one  recommended  by  him, 
as  the  cause  of  the  condition  should  be  known  before  the 
exercises  are  prescribed. 


FIG.  20.    The  ball  should  be  rolled  up  the  right  side,  across  the  top  of  the  abdomen,  and 

down  the  left  side. 


48  Personal  Hygiene  and  Home  Nursing 

The  hot-water  enema.  The  hot-water  enema,  another  remedy 
for  constipation,  may  be  most  beneficial  when  taken  under  the 
direction  of  a  physician,  but  injurious  if  depended  on  for  the  daily 
evacuation.  The  custom  often  is  to  take  large  enemas  of  two  or 
three  quarts,  and  by  hanging  the  bag  up  very  high  to  force  the 
water  well  up  into  the  colon,  the  idea  apparently  being  that  the 
more  water  and  force  used  the  more  efficacious  the  treatment  will 
be.  This  is  not  only  unnecessary  but  injurious.  When  such  a 
large  quantity  of  water  is  forced  high  up  into  the  large  intestine, 
it  may  lodge  in  that  part  of  the  intestine  lying  above  the  navel, 
and  by  its  weight  cause  a  sagging  down  of  the  intestine.  One  to 
two  pints  of  water  is  enough  to  empty  the  rectum,  and  is  less  in- 
jurious if  taken  cool  instead  of  hot.  Warm  water  enemas,  taken 
constantly,  help  to  relax  the  muscular  walls  of  the  intestine, 
especially  if  there  is  already  a  tendency  to  weakness  in  these 
muscles,  and  may  cause  a  state  of  chronic  dilatation. 

Simple  remedies.  Medicines  should  not  be  taken  unless  pre- 
scribed by  a  physician,  but  such  simple  remedies  as  these  may  be 
used: 

Water  in  abundance. 

Half  a  lemon  added  to  a  glass  of  water  and  taken  before  break- 
fast will  sometimes  act  upon  the  bowels.  It  is  not  injurious,  and 
being  persisted  in  for  a  week  or  ten  days  will  sometimes  relieve  an 
attack  of  constipation. 

Water  with  a  little  salt. 

Oils,  like  olive  oils  or  mineral  oils  ("  Nujol,"  "  Russian  Oil," 
"  American  Oil ")  lubricate  the  intestinal  tract  and  cause  a 
naturally  formed  movement.  They  can  be  taken  indefinitely 
without  injuring  the  intestines  or  upsetting  the  digestion.  If  the 
olive  oil  is  disagreeable  to  the  taste,  season  it  with  salt  and  lemon 
juice.  The  mineral  oils  are  tasteless,  but  if  disagreeable  to  take 
undiluted,  can  be  added  to  cold  water.  Holding  a  piece  of  ice  in 
the  mouth  just  before  taking  an  oil  prevents  any  disagreeable 
taste.  The  dose  of  oil  is  one  to  two  tablespoonfuls  taken  at  night 


Constipation  49 

and  in  the  morning,  or  only  at  night,  according  to  the  necessity 
of  the  case. 

Cathartics  and  their  effects.  A  cathartic  is  a  medicine  which 
causes  evacuations  of  the  bowels.  Cathartics  are  divided  into 
different  groups,  according  to  their  effect.  These  groups  are 
laxatives,  purgatives,  drastics,  hydragogues,  and  cholagogues. 

Laxatives  are  mild  cathartics  which  stimulate  peristalsis  and 
give  a  somewhat  softened,  almost  normal  evacuation.  Cascara 
sagrada,  citrate  of  magnesia,  glycerin,  and  olive  and  mineral  oils 
are  laxatives. 

Purgatives  are  more  decided  in  their  effects.  They  increase 
peristaltic  movement  in  the  intestine  and  are  followed  by  one 
or  more  almost  liquid  movements.  To  this  class  of  cathartics 
belong  aloes,  compound  licorice,  senna,  rhubarb,  and  castor  oil. 

Drastic  cathartics  cause  active  peristalsis  and  profuse  transuda- 
tion  of  fluid  through  the  walls  of  the  intestine,  which  results  in 
many  liquid  evacuations,  accompanied  by  griping  pain  in  the 
intestine.  Podophyllum,  jalap,  colocynth,  elaterium,  compound 
cathartic  pills,  and  croton  oil  are  the  best  known  of  these  drugs. 

Hydragogues  produce  large,  watery  movements  caused  by  an 
excessive  flow  of  liquids  from  the  blood  into  the  intestine.  To 
this  class  belong  Epsom  and  Rochelle  salts,  Seidlitz  powders, 
magnesium  citrate,  sodium  phosphate,  and  saline  waters. 

Cholagogues  stimulate  the  liver,  increase  the  flow  of  bile,  excite 
peristalsis,  and  are  followed  by  greenish  liquid  movements.  Calo- 
mel, podophyllum,  sodium  phosphate,  and  blue  mass  are  chola- 
gogues. 

Few  physicians  today  give  the  more  drastic  cathartics  except 
in  cases  of  absolute  necessity.  Such  cathartics  should  not  be 
taken  at  all  unless  ordered  by  a  physician.  Cathartics  of  the 
first,  second,  and  fourth  classes,  while  not  so  injurious,  should  not 
be  taken  constantly,  as  not  only  do  they  not  cure  constipation, 
but  some  of  them  will  even  cause  an  inflammation  of  the  intestine 
if  taken  for  a  long  time  in  increased  doses. 


50  Personal  Hygiene  and  Home  Nursing 

Cascara  sagrada  taken  in  large  doses  will  in  time  inflame  the 
intestine.  Aloin,  found  in  many  advertised  pills,  will  under  some 
conditions  cause  an  irritation  of  the  rectum  followed  by  hemor- 
rhoids. When  rhubarb  is  taken  alone  in  large  doses,  the  bowel 
movement  is  followed  by  constipation.  Senna  leaves  put  in  a 
bag  and  cooked  with  prunes  will  give  moderate  evacuations,  but 
will  not  help  permanently  to  relieve  the  constipated  condition. 

Castor  oil  can  be  used  to  clean  out  the  intestine  quickly  in  cases 
of  acute  indigestion  or  ptomain  poisoning,  but  each  dose  is  fol- 
lowed by  constipation  and  it  will  not  effect  a  cure  of  a  constipated 
condition.  Compound  licorice  powder  has  practically  no  curative 
powers. 

Saline  cathartics  taken  constantly  are  in  the  end  injurious. 
They  extract  fluid  from  the  walls  of  the  intestine,  induce  intestinal 
catarrh,  upset  the  digestion,  cause  an  anemic  condition,  and 
aggravate  rather  than  cure  the  trouble. 

Cork,  whole  flaxseed,  whole  mustard  seeds,  and  other  indigesti- 
ble substances  are  sometimes  used.  They  increase  peristalsis  in 
the  intestine  and  cause  more  frequent  evacuations,  but  are  very 
apt  to  start  inflammation  in  the  intestine.  Regulin,  a  popular 
remedy,  made  of  agar-agar  and  cascara  sagrada,  is  the  least  in- 
jurious of  these  remedies,  but  even  this  should  not  be  taken  during 
a  long  period. 

Calomel  and  blue  mass  are  useful  in  their  places,  but  calomel, 
particularly,  is  taken  much  too  freely.  Even  when  given  in  small 
doses  it  should  not  be  taken  frequently.  Many  people  have  what 
might  be  called  the  calomel  habit,  taking  heavy  doses  of  this  drug 
upon  the  slightest  excuse.  Often  when  they  decide  that  there  are 
symptoms  indicating  the  need  of  calomel,  there  is  absolutely  no 
necessity  for  the  dose.  Calomel  is  a  derivative  of  mercury,  and 
in  large  doses,  or  in  some  individuals  even  when  carefully  taken 
in  small  doses,  it  may  cause  symptoms  of  mercurial  poisoning,  such 
as  nausea,  abdominal  pain,  diarrhea,  and  ulcerated  mouth.  It 
has  a  harmful  effect  upon  the  teeth,  sometimes  causing  a  condition 


Constipation  51 

spoken  of  as  salivation,  in  which  the  gums  recede  and  the  teeth 
fall  out. 

One  physician  who  is  a  specialist  in  digestive  diseases  has  made 
the  statement  that  the  cause  of  the  illness  of  at  least  one  third  of 
his  patients  is  the  habit  of  taking  calomel.  It  is  an  excellent  remedy 
in  the  hands  of  an  intelligent  physician,  but  should  be  used  only 
under  his  direction.  Cathartics  of  any  class  should  be  taken 
only  for  temporary  relief,  except  in  the  case  of  old  people,  where 
there  is  no  chance  of  making  a  cure ;  and  even  in  these  cases  the 
prescription  should  be  made  by  a  physician. 


CHAPTER   EIGHT 

EARS,    THROAT,   AND    NOSE 

THE  ears,  throat,  and  nose  are  so  closely  related  anatomically 
that  a  disease  affecting  one  of  these  organs  is  likely  to  affect  them 
all.  The  various  parts  of  the  body  are,  in  fact,  far  more  closely 
related  to  one  another  than  one  might  think,  and  an  ailment 
which  seems  to  be  confined  to  one  organ  may  be  the  result  of 
trouble  in  some  other  part.  It  is  not  safe  to  overlook  any  diseased 
condition  under  the  impression  that  its  effects  will  be  limited  to 
one  part  of  the  body ;  if  a  cold  is  neglected  and  becomes  catarrh 
or  bronchitis,  the  local  disease  reacts  upon  the  whole  system  and 
the  general  vitality  is  lowered.  The  general  effects  of  diseases 
affecting  the  ears,  nose,  and  throat  should  be  especially  watched, 
since  these  ailments  are  likely  to  interfere  with  the  breathing  and 
the  digestion. 

Anatomy  of  the  ear.  The  ear  is  not  only  one  of  the  most 
important  organs  in  the  whole  body,  but  one  of  the  most  delicate, 
and  it  needs  much  more  careful  attention  than  it  usually  receives. 
It  is  divided  into  three  parts,  the  outer,  the  middle,  and  the  inner 
ear. 

The  outer  ear  is  composed  of  the  auricle,  or  what  we  commonly 
call  the  ear,  and  a  tube  or  canal  leading  into  the  middle  ear.  At 
the  inner  end  of  this  tube  and  separating  the  outer  and  middle 
ear  is  the  tympanic  membrane  or  "  drumhead."  The  auricle  is 
of  a  shape  suited  to  catch  the  wave  of  sound  and  convey  it  into 
the  tube.  In  the  walls  of  the  tube  or  canal  of  the  ear  are  glands 
which  secrete  wax,  which  is  for  the  purpose  of  protecting  the  canal 
from  the  entrance  of  insects.  Normally  this  is  secreted  only  in 
sufficient  quantity  to  do  its  work,  and  any  abnormal  production 
is  due  to  inflammation.  Digging  into  the  ear  with  hairpins  or 
pins  will  cause  an  abnormal  secretion  of  wax.  One  of  the  common 
causes  of  deafness  is  an  overaccumulation  of  wax  in  the  canal 
and  on  the  eardrums,  interfering  with  the  progress  of  the  waves 
of  sound. 

5-' 


Ears,  Throat,  and  Nose 


53 


mastoid 
cavity 


nerve 


The  middle  ear  is  a  small,  drum-shaped  cavity  in  the  temporal 
bone,  called  the  tympanum.  It  is  filled  with  air  which  it  obtains 
through  the  Eustachian  tube, 
from  the  throat.  The  Eus- 
tachian tube  makes  a  direct 
connection  between  the 
throat  and  the  middle  ear. 
This  connection  with  the 
throat  is  cut  off  by  a  small 
membrane  which  covers  the 
end  of  the  tube  like  a  little 
lid,  and  is  closed  except 
during  the  act  of  swallow- 
ing. The  tympanum  also 
connects  with  a  number  of 
small  cavities  or  sinuses  in 
the  temporal  bone.  The 
largest  of  them  is  the  mas- 
toid sinus,  which  is  in  the  bony  prominence  behind  the  ear. 

Within  the  tympanum  are  three  little  bones,  the  malleus 
(hammer),  the  incus  (anvil),  and  the  stapes  (stirrup),  thus  named 
because  of  their  shapes.  They  form  a  chain  across  the  tympanum, 
connecting  the  tympanic  membrane  with  the  inner  ear. 

The  inner  ear,  like  the  middle  ear,  is  hollowed  out  in  a  very 
complex  manner  in  the  temporal  bone.  It  consists  of  three  parts : 
the  vestibule,  the  cochlea,  and  the  semicircular  canals.  This  bony 
labyrinth  is  filled  with  a  liquid  in  which  like  a  detached  lining  lies 
a  membranous  labyrinth  similar  in  form  to  the  bony  labyrinth. 
The  auditory  nerve  which  connects  the  ear  with  the  brain  ter- 
minates in  this  membrane.  The  branch  which  passes  from  the 
cochlea  to  the  brain  carries  the  impulses  which  give  the  sensation 
of  sound.  When  a  wave  of  sound  enters  the  external  ear,  it  passes 
through  the  outer  canal,  strikes  against  the  tympanic  membrane, 
and  causes  the  bones  of  the  middle  ear  to  vibrate.  These  bones 


middle  ear    Eusta- 
chian tube 

FIG.  21.     Diagram  of  the  ear. 


54  Personal  Hygiene  and  Home  Nursing 

are  so  connected  with  the  inner  ear  that  their  vibration  sets  the  fluid 
in  it  in  motion,  and  when  the  waves  in  this  fluid  strike  against  the 
endings  of  the  auditory  nerve  the  impulses  are  conveyed  to  the 
brain. 

Causes  of  deafness.     Deafness  may  be  due  to  several  causes: 

(1)  Accumulation  of  wax  in  the  outer  ear.     When  this  accumu- 
lates in  too  great  amounts  it  should  be  removed  by  washing  out 
the  ear.     When  hardened  wax  has  accumulated  in  the  ear,  it  may 
be  necessary  to  visit  a  physician  to  have  it  removed. 

(2)  Injury  to  the  drumhead.     This  is  often  the  result  of  the  air 
being  suddenly  forced  against  it  by  a  violent  blow,  of  perforation 
by  the  point  of  a  hairpin  or  other  sharp  instrument,  or  of  an  accu- 
mulation of  pus  in  the  middle  ear. 

(3)  Infections  of  the  ear.     Earache,  running  ears,  abscesses  in 
the  ears,  and  practically  all  other  troubles  with  the  middle  and 
inner  ears  are  due  to  infections  with  germs.     Very  frequently  in 
young  children  the  germs  of  colds  find  their  way  up  the  Eustachian 
tube  and  attack  the  middle  ear  as  well  as  the  mucous  membrane 
of  the  nose  and  throat. 

In  scarlet  fever  the  ears  are  attacked,  and  infections  and  ab-  • 
scesses  in  the  ears  often  follow  cases  of  grippe.  Persons  with 
infected  tonsils  and  adenoid  growths  are  especially  likely  to  suffer 
from  ear  troubles,  the  germs  working  up  the  Eustachian  tubes 
from  the  infected  centers  in  the  throat.  Violent  blowing  of  the 
nose  or  improper  use  of  the  nasal  douche  may  force  germs  from  the 
mouth  and  throat  into  the  Eustachian  tube  and  start  inflammation 
there.  Unless  this  inflammation  is  treated  and  cured,  the  walls 
of  the  tube  become  swelled  and  thickened  and  the  air  supply  to 
the  middle  ear  is  lessened  or  even  cut  off.  Sometimes  in  an  in- 
fected ear  the  chain  of  bones  is  broken  down  or  the  joints  between 
the  little  bones  become  stiff.  This  prevents  the  transmission  of 
the  waves  of  sound  and  causes  deafness. 

Treatment  of  deafness.     Many  cases  of  deafness  can  be  cured 
if  taken  in  time.     Specialists  are  often  unable  to  cure  some  par- 


Ears,  Throat,  and  Nose  55 

ticular  case  because  they  were  not  consulted  until  too  late  to  make 
the  cure  -possible.  The  first  symptom  of  deafness  should  be  the 
signal  for  a  thorough  examination  by  a  specialist.  If  the  treat- 
ment is  begun  upon  the  first  evidence  of  inflammation  in  the  ear, 
a  quick  cure  may  be  possible. 

If  there  is  any  trouble  in  the  nose  or  throat,  these  parts  should 
be  treated.  It  is  usually  impossible  to  treat  infections  of  the 
middle  ear  successfully  with  the  tonsils  or  adenoid  growths  serving 
as  breeding  places  for  germs  at  the  mouths  of  the  Eustachian  tubes. 
A  common  mistake  in  the  treatment  of  ear  trouble  is  that  of  dis- 
continuing treatment  before  a  complete  cure  is  made.  If  the 
inflammation  has  continued  for  months,  or  if  the  tubes  have  be- 
come at  all  thickened,  it  is  out  of  the  question  to  effect  a  cure  in 
a  short  time. 

Earache.  Earache  should  never  be  neglected.  Owing  to  the 
openings  between  the  middle  ear  and  the  sinuses  in  the  bone  about 
it,  an  abscess  in  the  ear  may  spread  until  the  bone  itself  is  affected. 
Pus  must  find  an  outlet.  When  contained  in  a  bony  substance 
it  is  not  only  extremely  painful,  but,  unless  an  outlet  is  provided, 
it  will  penetrate  into  the  tissue  or  through  the  membrane.  Thus 
an  abscess  in  the  ear  spreading  into  the  mastoid  cavity  causes 
mastoiditis,  and  unless  relieved  by  operation,  may  penetrate  into 
the  brain  and  cause  an  abscess  in  the  brain  which  eventually  may 
be  fatal.  Nothing  will  check  the  spread  of  infection  in  the  ear  so 
effectively  as  an  opening  in  the  tympanic  membrane  through  which 
the  pus  may  escape.  The  small,  clean-cut  incision  made  by  a 
surgeon  will  close,  and  does  not  injure  the  membrane  as  it  will  be 
injured  if  the  pus  is  allowed  to  force  its  own  way  through.  If 
there  is  earache,  no  time  should  be  lost  in  consulting  a  specialist. 

Temporary  relief  of  pain  in  the  ear.  One  must  be  very  careful 
in  inserting  anything  into  the  ear,  for  digging  into  the  ear  canal 
not  only  increases  the  accumulation  of  wax,  but  may  cause  a  con- 
dition of  inflammation  in  the  ear  or  even  perforate  the  drumhead. 
For  the  relief  of  pain,  hot  cloths  or  a  hot-water  bag  may  be  applied 


Personal  Hygiene  and  Home  Nursing 


externally;  but  hot  oils  or  medicines  should  never  be  dropped 
into  the  ear,  nor  should  poultices  be  applied,  nor  the  ear  syringed 
out,  except  by  the  order  of  a  physician. 

Irrigating  the  ear.  The  simplest  and  best  way  to  irrigate  the 
ear  is  with  an  all-rubber  ear  syringe  or  a  fountain  syringe  and  a 
small  point,  using  tepid  water  and  not  hanging  the  bag  higher  than 
is  absolutely  necessary  to  allow  the  water  to  run.  No  force  should 
be  used.  The  majority  of  piston  syringes  get  out  of  order  soon, 
and  are  hard  to  work  smoothly. 

The  throat.  It  is  not  necessary  in  a  small  book  like  this  to  enter 
into  a  full  description  of  the  anatomy  of  the  throat,  but  it  is  im- 
portant to  call  attention  to  the  fact  that  any  disease  of  the  throat 
must  inevitably  affect  the  system  very  directly.  One  of  the 
commonest  causes  of  such  disease  is  adenoid  growths  or  an  in-, 
fected  condition  of  the  tonsils.  The  healthy  state  of  these  parts 

is  of  the  greatest  impor- 
tance to  every  individual, 
and  has  much  to  do  with 
the  health  and  develop- 
ment of  children. 

Adenoids  and  infected 
tonsils.  The  tonsils  are 
two  bodies  of  soft  tissues, 
one  on  either  side  of  the 
throat.  High  in  the  back 
of  the  throat  behind  the 
openings  from  the  nose 
lies  a  third,  small  tonsil. 
When  this  third  tonsil 
becomes  enlarged,  it  is 
called  an  adenoid  or  an 
adenoid  growth.  During 
childhood  tonsils  are  al- 


Eustachian  tube 
soft  palate 


<osition  of 
adenoids 
tonsil 


FIG.  22.    The  nasal  passages,  mouth,  and  throat. 


ways  somewhat  enlarged,  but  unless  they  become  diseased  they 


Ears,  Throat,  and  Nose 


57 


An     adenoid 


gradually  become  smaller,  until,  in  adult  life,  they  can  hardly 
be  seen  at  all. 

Because  of  their  position  in  the  throat 
and  because  of  their  spongy  nature  and  the 
fact  that  they  have  crypts  and  openings 
leading  down  into  them,  the  tonsils  often 
become  infected  with  germs.  They  then 
serve  as  breeding  centers  for  pus-forming 
bacteria;  and  in  the  diseased  tissues  of 
infected  tonsils  diphtheria  germs,  tubercu- 
losis germs,  and  perhaps  the  germs  of  other 
diseases,  like  influenza,  colds,  and  pneu- 
monia, find  a  fertile  soil  for  growth.  It  is  FIG.  23. 
believed,  also,  that  germs  and  toxins  from  growth  in  the  throat  seen 

from    the    front.      (After 

the  tonsils  are  carried  through  the  whole   wingrave.) 

body  and  cause  such  diseases  as  hardening 

of   the  arteries,  rheumatism,  and   other   chronic   ailments.     In 

many  cases  of  chronic  infection  of  the  tonsils  there  is  no  pain  at 

all,  and  the  trouble  cannot  be  detected  by  casual  examination. 

Effects  of  adenoids  and  enlarged  tonsils.  A  child  having  en- 
larged tonsils  and  adenoid  growths  has  difficulty  in  breathing 
through  the  nose,  and  sleeps  with  the  mouth  open.  The  nose, 
having  been  evolved  for  breathing  purposes,  warms  the  air  as  it 
enters,  and  the  sticky  mucous  membrane  with  which  the  nasal 
passages  are  lined  catches  the  dust  and  thus  purifies  the  air.  When 
cold  air  is  breathed  in  through  the  mouth,  it  is  taken  directly  into 
the  throat  and  passes  unwarmed  even  into  the  trachea  and 
bronchial  tubes,  and  the  impurities  it  contains  have  no  chance  of 
being  sifted  out,  but  are  drawn  into  the  air  passages  and  lungs. 

A  child  with  adenoid  growths  does  not  develop  as  it  should. 
As  a  rule  such  children  are  pale  and  nervous,  do  not  sleep  well, 
have  little  appeHte  and  poor  digestion,  contract  diseases  readily, 
and  are  more  or  less  retarded  both  in  'mental  and  physical  develop- 
ment. Frequent  colds  and  abscesses  in  the  ear,  even  deafness, 


58  Personal  Hygiene  and  Home  Nursing 

may  result.  After  the  removal  of  the  tonsils  and  adenoids  the 
improvement  is  marked.  Backward  children  often  become 
mentally  alert,  their  physical  development  improves,  and  in  a 
year  or  two  after  such  an  operation  the  child  may  be  hardly  rec- 
ognizable. Only  a  skilled  surgeon,  of  course,  should  perform  this 
operation,  and  the  patient  should  be  given  an  anaesthetic.  Al- 
though a  simple  operation  it  is  a  delicate  one,  as  the  organs  lie 
close  to  important  blood  vessels. 

Operations  on  the  tonsils  and  adenoids.  Any  one  who  has  seen 
a  case  of  diseased  tonsils  and  adenoids  before  and  after  the  opera- 
tion for  removal  would  never  hesitate  about  deciding  to  have 
this  operation  performed  upon  a  child.  The  increased  appetite, 
added  weight,  and  change  in  mental  and  physical  development 
are  unmistakable.  It  may  be  hard  for  the  parent  to  consent  to 
the  operation,  but  the  longer  a  diseased  tonsil  is  left  in  the  throat, 
the  weaker  the  body  becomes  and  the  greater  is  the  danger  from 
the  operation ;  also  the  improvement  after  the  operation  has  been 
performed  is  far  slower. 

Many  cases  have  come  under  my  notice  in  which  the  result  of 
an  operation  on  a  child  affected  the  parents  in  a  very  interesting 
manner.  In  one  family,  in  which  the  father  insisted  that  he  did 
not  believe  in  operations  in  any  circumstances,  the  tonsils  of  one 
child  became  so  diseased  that  the  physician  in  charge  refused  to 
take  the  responsibility  for  the  patient's  life  without  an  operation, 
and  the  father  was  obliged  to  consent.  The  improvement  in  the 
child,  both  physical  and  mental,  was  so  extraordinary  that  the 
father  has  not  only  had  his  second  child  operated  upon,  but  fre- 
quently advises  other  parents  to  take  their  children  for  examina- 
tion, and  even  blames  them  for  hesitating  in  case  the  operation 
is  advised.  One  boy  whom  I  knew  was  so  thin,  at  the  age  of  four 
or  five  years,  that  he  was  a  pathetic  sight.  He  had  never  had  an 
appetite,  and  had  to  be  coaxed  and  persuaded  to  eat  at  all.  A 
year  after  the  removal  of  his  tonsils  his  mother  was  heard  to  say 
that  she  almost  wished  that  part  of  them  could  be  put  back  because 


Ears,  Throat,  and  Nose 


59 


it  was  so  difficult  to  get  enough  for  him  to  eat.  Now,  after 
four  or  five  years,  he  is  a  fine,  well-grown,  sturdy  boy,  very 
much  alive,  mentally  and  physically. 
The  immediate  bad  effects  of  such 
an  operation  last  only  a  short  while. 
The  child  may  show  little  general 
improvement  for  possibly  two  or 
three  months,  but  at  the  end  of  that 
time  the  gain  will  begin,  and  one 
will  never  be  sorry  that  the  opera- 
tion was  performed.  For  two  or 
three  days  after  the  operation  the 
patient  should  be  kept  in  bed,  and  FIG.  24.  A  cross-section  of  the 
should  not  be  left  alone  for  fear  of  nasal  chambers,  showing  the  turbi- 

,  ,  „-,,  .  ,  ,  nated  bones  (a,  b,  and  c)  over  which 

hemorrhage.     This  rarely  occurs,  but    the  air  passes.    The  thin  dark  line 

is  a   possibility.      If   it   does   OCCUr,  a    in  the  center  is  the  septum,  which 

physician   should   be   summoned,   the    separates  the  two  sides  of  the  nose. 

i.,,,        u  i      i  i       1.1  •    ,       The  mucous  membrane  is  shown  in 

child  should  be  kept  absolutely  quiet,    white 
and  ice  compresses  should  be  applied 

on  the  outside  of  the  throat.  For  a  few  hours  there  will  be  vomit- 
ing of  mucus  and  blood.  This  blood  is  not  an  indication  of  hemor- 
rhage, but  is  the  blood  which  has  been  swallowed  during  the  opera- 
tion. 

The  child  should  not  become  overfatigued,  or  exposed  to  sudden 
chill,  and  should  be  kept  on  liquid  diet  for  two  or  three  days.  Ice 
cream  is  permitted  by  most  surgeons  soon  after  the  operation. 
It  is  nourishing,  and  cooling  to  the  inflamed  throat,  and  is  fre- 
quently a  great  help  in  keeping  a  child  contented  during  the  dis- 
comfort of  the  first  two  or  three  days. 

Anatomy  of  the  nose.  The  two  nostrils  open  back  into  a  cham- 
ber which  is  divided  into  two  parts  by  a  thin  bone  called  the  septum. 
Projecting  out  from  the  walls  of  these  two  chambers  are  other 
thin  bones  of  irregular  shape  which  are  called  the  turbinated  bones. 
When  the  air  is  drawn  into  the  nose,  it  passes  over  the  turbinated 


6o 


Personal  Hygiene  and  Home  Nursing 


bones  and  is  thus  warmed  and  cleansed  of  its  dust.     In  the  bones 
of  the  face  are  cavities  called  sinuses,  which  connect  by  small 




nasal  passage        nasal  passa# 

Frontal  lirais 


Opening  f 
nasa 


FrontaJ  sinuses 


Maxillary 


FIG.  25.    The  skull,  showing  the  location  of  the  frontal  and  maxillary  sinuses. 

openings  with  the  two  chambers  of  the  nose.  In  the  forehead  are 
the  frontal  sinuses;  in  the  cheek  bones  the  maxillary  sinuses;  and 
above  and  to  the  back  of  the  nasal  chambers  are  the  ethmoidal 
and  sphenoidal  sinuses.  These  sinuses  are  air  chambers  and  are 
lined  with  mucous  membrane  of  the  same  nature  as  that  found 
in  the  mouth,  nose,  and  throat. 

Abnormal  growths  in  the  nose.  The  nose  may  become  stopped 
up  and  breathing  be  interfered  with  by  the  growth  of  parts  of  the 
mucous  membrane  into  what  is  called  polyps.  In  a  certain  dis- 
eased condition  of  the  nose  the  turbinated  bones  become  thickened 
and  partly  close  the  opening  of  the  nostrils.  Or  the  septum  may 
become  bent  and  bowed  out  to  one  side  so  that  it  partially  or  almost 

entirely  blocks  one  side  of  the 
nose.  These  conditions  will  cause 
mouth  breathing  as  surely  as 
will  adenoid  growths,  and  such 
growths  should  be  removed  by 
operation,  to  prevent  the  evil 
consequences  of  mouth  breathing 
and  promote  the  general  health. 
There  can  be  no  wholesome 
physical  development  without 
abundant  fresh  air  for  the  lungs. 


Wire  to 
na^al  passage 


Sphenoidal  sinus 


FIG.  26.  Section  through  skull,  showing 
location  of  ethmoidal  and  sphenoidal 
sinuses. 


CHAPTER   NINE 
COLDS 

THERE  are  few  subjects  upon  which  it  is  more  difficult  to  advise 
than  that  of  preventing  and  curing  colds,  because  our  knowledge 
of  this  subject  is  inadequate  and  incomplete.  Colds  are  now 
known  to  be  germ  diseases,  and  a  number  of  different  germs  that 
grow  on  the  mucous  membranes  of  the  respiratory  passages  may 
have  a  part  in  causing  them.  The  acute  epidemic  colds  that 
sweep  whole  communities  are  doubtless  caused  by  especially 
virulent  germs  that  are  handed  on  from  one  person  to  another. 
Just  how  the  germs  of  chronic  colds  and  catarrhs  from  which  many 
persons  suffer  are  related  to  the  germs  of  epidemic  colds  is  not  yet 
well  established.  Perhaps  they  are  entirely  different  kinds  of 
germs  ("  secondary  invaders  ")  that  attack  the  mucous  mem- 
branes after  they  have  been  weakened  by  epidemic  colds  and 
succeed  in  making  in  them  a  more  or  less  permanent  home ;  or  it 
may  be  that  the  germs  of  acute  colds  in  some  cases  may  become 
changed  and  in  a  less  virulent  form  become  the  cause  of  chronic 
colds. 

It  is  common  for  those  who  have  been  camping  out  and  sleeping 
in  the  open  air,  or  for  lumbermen  fresh  from  the  pure,  cold  air  of 
the  woods,  to  contract  a  cold  immediately  on  returning  to  indoor 
life.  This  makes  it  certain  that  a  cold,  in  spite  of  its  name,  is 
caused  not  by  cold  on  the  body  but  by  germs  that  pass  from  one 
person  to  another.  Like  consumption  and  catarrh,  colds  are 
most  prevalent  among  those  who  keep  their  windows  closed  and 
are  afraid  of  drafts,  even  when  they  are  warmly  clothed. 

Prevention  of  colds.  The  conclusions  that  we  can  reach  in  re- 
gard to  colds  are  (i)  that  a  cold  is  caused  by  the  presence  of  germs, 
and  (2)  that  by  raising  the  resisting  powers  of  the  body  attacks 
of  colds  may  be  in  some  cases  avoided  and  in  other  cases  made 
less  prolonged  and  less  severe.  Our  efforts  toward  avoiding  these 
ailments  must,  therefore,  be  directed  to  keeping  the  germs  from 
entering  the  body  or  to  building  up  the  health  so  that  the  body 

61 


62  Personal  Hygiene  and  Home  Nursing 

will  be  strengthened  in  its  resistance  to  the  germs.  For  the  aver- 
age person  it  is  probable  that  the  only  sure  protection  against 
epidemic  colds  is  the  avoidance  of  the  germs,  just  as  the  avoidance 
of  the  germs  of  measles,  scarlet  fever,  and  other  acute  infections 
is  the  only  certain  safeguard  against  these  diseases.  Against  the 
slower  chronic  colds  a  vigorous  condition  of  the  body  is  the  best 
defense. 

The  germs  of  colds  may  be  breathed  in  from  droplets  sneezed 
or  coughed  into  the  air  in  elevators,  crowded  buildings,  and  street 
cars.  They  are  found  on  public  drinking  cups,  towels,  pencils, 
and  other  articles  handled  by  infected  persons,  and  they  may  be 
transferred  directly  to  our  hands  from  the  hands  of  such  persons. 
For  this  reason  one  should  not  use  public  cups  and  towels  if  their 
use  can  by  any  means  be  avoided.  We  should  never  put  a  pencil 
or  coin  into  the  mouth,  and  the  hands  should  not  be  brought  to 
the  mouth  or  face  and  should  not  touch  the  food  that  we  eat 
unless  they  have  been  freshly  washed. 

After  being  with  one  who  is  suffering  from  a  cold,  it  is  well  to 
wash  the  hands  thoroughly  with  soap  and  to  douche  the  nostrils 
and  use  a  gargle.  Normal  salt  solution  —  one  teaspoon  of  salt  to 
a  pint  of  water  —  is  excellent  for  the  latter  purpose.  The  douche 
of  salt  solution  may  be  followed  by  one  of  oil,  or  vaselin  may  be 
put  up  the  nose  with  the  little  finger  and  snuffed  back.  The  douche 
dissolves  the  mucus  in  the  nose,  and  the  oil  is  soothing  and  healing 
to  the  mucous  membrane. 

Low  resistance  to  germs  may  be  caused  by  indigestion,  constipa- 
tion, overfatigue,  lack  of  fresh  air,  want  of  sleep,  want  of  proper 
food,  or  in  fact  by  anything  which  lowers  the  general  bodily  vitality. 
The  sudden  chilling  of  the  body  by  going  out  into  the  cold  or  stand- 
ing or  sitting  in  a  current  of  air  without  sufficient  protection  may 
also  tend  to  lower  the  resistance  to  germs.  Getting  the  feet  wet 
and  keeping  on  the  wet  shoes,  or  sitting  in  damp  clothes,  has  a 
similar  effect.  Sometimes  dust  will  cause  an  irritation  of  the 
mucous  membrane,  permitting  the  development  of  disease  germs. 


Colds  63 

One  cold  often  leads  to  another  because  of  the  lowered  bodily 
resistance  following  the  first  attack,  and  because  the  semi-in- 
flamed mucous  membrane  makes  a  more  inviting  soil  for  the  growth 
of  the  germs. 

A  person  subject  to  colds  should  try  in  every  way  to  put  the 
body  into  that  condition  of  strength  and  good  health  which  will 
enable  it  to  resist  the  disease.  Diet  should  be  carefully  considered, 
and  should  include  a  variety  of  digestible  foods,  but  nothing  not 
easily  digested.  The  bowels  should  be  kept  moving  regularly. 
Exercise  in  the  fresh  air  and  a  proper  amount  of  sleep  are  also 
important.  Sleeping  out  of  doors  is  one  of  the  popular  preventives 
of  cold ;  both  the  abundance  of  fresh  air  and  the  hardening  of  the 
body  are  helpful.  It  should  not  be  done  first  in  winter,  but  the 
practice  should  be  begun  in  summer  and  continued  through  the 
cold  weather.  The  bed  clothing  should  be  warm,  and  one  should 
not  continue  outdoor  sleeping  if  unable  to  keep  warm  (page  31). 
Cold  baths,  taken  properly,  are  of  benefit;  salt  rubs  stimulate 
the  skin  and  give  tone  to  the  nervous  system ;  a  cold  shower  may 
be  beneficial  (page  5). 

Curing  a  cold.  Upon  feeling  the  first  symptoms  of  a  cold,  such 
as  chilliness,  fever,  headache,  or  sore  throat,  it  is  best  to  go  to  bed, 
and  to  clear  the  bowels  out  thoroughly  with  a  laxative.  Hot 
lemonade  with  a  slight  stimulant  in  it  may  also  be  beneficial,  but 
if  taken,  it  should  be  immediately  before  going  to  bed.  A  hot 
bath  will  help  to  draw  the  blood  away  from  the  congested  parts 
and  equalize  the  body-  temperature.  The  body,  especially  the 
feet,  should  be  kept  warm,  water  should  be  taken  in  abundance, 
and  only  the  most  easily  digested  food  should  be  eaten. 

Many  medicines  for  curing  colds  are  sold,  and  some  are  helpful 
if  taken  in  the  first  stages  of  the  disease.  Many,  however,  are 
harmful,  and  no  medicines  should  be  taken  unless  advised  by  a 
physician.  Steam  inhalations  are  useful  for  clearing  out  the 
nostrils,  but  should  not  be  taken  immediately  before  going  out  of 
doors.  There  are  several  types  of  apparatus  sold  for  use  in  taking 


Personal  Hygiene  and  Home  Nursing 


FIG.  27.  A  funnel  for  steam  inhala- 
tions, made  by  rolling  a  towel  and  a 
paper  together. 


steam  inhalations,  but  a  satisfactory  substitute  can  be  made  with 
a  pitcher  and  a  newspaper  or  towel  folded  into  a  funnel  shape. 

The  boiling  water  and  medicine 
are  put  in  the  pitcher,  and  one 
end  of  the  funnel  placed  over  the 
pitcher  and  one  end  over  the 
face.  A  solution  which  is  often 
used  for  a  steam  inhalative  is 
made  of  tincture  of  benzoin,  one 
teaspoonful  to  one  pint  of  water. 

Blowing  the  nose  irritating  to 
the  mucous  membrane.  The 
membrane  within  the  nose  and 
the  skin  outside  are  irritated  by 
constant  use  of  the  handkerchief 
in  blowing  the  nose.  This  can 

be  avoided  by  the  use  of  oil  or  vaselin,  which  also  helps  to  keep 
the  nose  clear  during  the  night,  and  is  particularly  good  in  the  case 
of  infants  and  young  children.  Liquid  vaselin  may  be  used,  and 
with  children  may  be  injected  gently  into  the  nostril  with  a  medi- 
cine dropper.  A  wooden  toothpick  or  match  upon  which  a  pledget 
of  absorbent  cotton  has  been  twisted,  may  be  used  to  insert  vaselin. 
When  blowing  the  nose  during  a  cold  or  after  the  use  of  a  spray, 
the  sides  of  the  nose  should  not  be  compressed  with  the  fingers, 
but  the  handkerchief  should  be  held  in  front  of  the  nostril,  and 
with  the  mouth  slightly  open  the  nose  should  be  blown  free.  Blow- 
ing the  nose  violently  while  one  side  is  closed  may  force  air  and 
germs  into  the  Eustachian  tube  and  into  the  sinuses  of  the  bones 
of  the  face,  and  may  start  inflammation  in  those  parts  (page  60). 
Chronic  colds.  Colds  in  the  head  should  not  be  allowed  to 
continue  until  chronic.  With  chronic  colds,  the  membranous 
lining  of  the  nose  and  the  thin  bones  within  it  may  become  thick- 
ened, or  the  infection  may  spread  into  the  various  sinuses  and 
cause  inflammation  lasting  for  weeks  and  months.  When  pus 


Colds  65 

forms  in  the  sinuses,  there  is  frequently  pain  and  headache.  There 
is  also  a  steady  discharge  from  the  nose  and  possibly  into  the 
throat,  and  at  times  this  causes  the  breath  to  have  an  offensive 
odor. 

In  many  chronic  colds  the  seat  of  the  trouble  is  some  focus  of 
infection  in  the  tonsils  or  in  some  of  the  sinuses  in  the  head ;  or 
the  difficulty  may  be  that  enlarged  or  bent  bones  interfere  with 
the  proper  drainage  of  the  nose  (pages  59-60).  In  any  case  a 
specialist  should  be  consulted  and  treatments  be  given,  or  if 
necessary,  an  operation  performed. 


THE  EYES 

THE  eye  is  one  of  the  most  delicate  and  easily  abused  organs  of 
the  body,  and  undoubtedly  the  most  carelessly  used  of  all.  Its 
formation  is  exquisite,  its  muscular  arrangement  wonderful,  and  its 
nervous  mechanism  complicated  and  curious  in  the  extreme.  Some 
of  its  muscles  are  so  delicate  that  they  can  be  seen  only  under  the 
microscope,  and  at  the  same  time  they  are  powerful  enough  to  do 
a  work  far  greater  in  proportion  to  their  size  than  that  of  any  other 
muscle  in  the  body.  It  is  fine,  close  work  that  puts  a  strain  on 
the  eyes ;  and  so  much  work  of  this  kind  has  come  into  our  modern 
life  that  the  demands  on  these  sensitive  organs  are  far  more  severe 
than  the  eyes  of  primitive  man  were  called  on  to  meet.  As  a 
consequence,  much  inconvenience  or  even  actual  illness  may  be 
due  to  trouble  with  the  eyes,  and  it  is  important  to  know  how  to 
relieve  them  from  unnecessary  strain. 

Structure  of  the  eye.  The  pupil  of  the  eye  expands  or  contracts 
according  to  the  amount  of  light  admitted.  Behind  the  pupil 
is  a  lens  which  focuses  the  light  as  does  the  lens  of  a  "camera.  The 
lens  of  the  eye  changes  its  shape  according  to  the  necessity  for 
far  or  near  vision,  becoming  flattened  when  distant  objects  are 
looked  at  and  rounded  out  for  seeing  objects  close  at  hand.  The 
muscles  which  regulate  the  form  of  the  lens  are  so  delicate  and  fine 
as  to  be  named  the  ciliary,  or  hairlike,  muscles. 

In  addition  to  the  changes  that  take  place  within  the  eye  for 
clear  vision,  the  eye  as  a  whole  must  be  turned  in  its  socket  toward 
the  objects  we  wish  to  examine.  These  movements  are  brought 
about  by  external  muscles,  six  of  which  are  attached  to  each  eye. 
When  these  muscles  do  not  do  their  work  effectively  so  that  the 
two  eyes  are  not  directed  toward  the  same  object,  the  person  is  said 
to  squint  or  to  be  cross-eyed.  To  look  at  an  object  held  close  to 
the  eyes  requires  that  the  two  eyes  be  turned  inward  and  throws 
a  strain  on  the  muscles  that  cause  this  movement.  For  this  reason 
close  work  may  strain  not  only  the  muscles  that  govern  the  move- 

66 


The  Eyes  67 

ments  of  the  eye  as  a  whole,  but  also  the  ciliary  muscles  that 
regulate  the  shape  of  the  lens. 


sclerotic  coat 

choroid  coat 
optic  nerve 


muscles 


FIG.  28.     A  diagram  showing  the  structure  of  the  eye. 

It  should  be  noted  that,  in  young  children  who  are  cross-eyed, 
the  failure  to  move  the  eyes  together  is  due  not  to  any  trouble  with 
the  muscles  but  to  the  fact  that  the  sight  in  one  eye  is  weak  and 
that  eye  is  not  being  used.  The  difficulty  is  that  the  eye  is  near- 
sighted or  far-sighted  or  is  in  some  other  way  defective,  so  that  the 
image  on  the  retina  is  indistinct.  The  visual  impulses  from  this 
eye  are  therefore  disregarded  and  the  eye  is  allowed  to  move  about 
at  will  instead  of  being  directed  with  the  other  eye  toward  objects 
that  are  being  looked  at.  The  trouble  can  be  cured  only  by  glasses 
that  will  remedy  the  refractive  difficulties  and  cause  the  image  to  be 
sharply  focused  on  the  retina.  This  should  be  done  in  the  very 
early  years  of  life,  for  if  the  eye  is  not  used  through  childhood  the 
sense  of  sight  in  it  is  practically  lost.  Later  an  operation  on  the 
muscles  may  improve  the  appearance  of  the  person,  but  it  will  not 


68  Personal  Hygiene  and  Home  Nursing 

make  the  eye  an  efficient  organ  of  vision.     Carrying  the  head  to  one 

side  is  an  indication  of  trouble  with  the  eyes. 

Saving  the  eyes  from  strain. 
One  of  the  commonest  ways  in 
which  the  eyes  are  strained  is  in 
reading  books  of  too  fine  type, 
or  type  which  is  blurred  and  in- 
distinct. If  this  is  necessary,  the 

optic  nerve  reading  should  not  be  kept  up 

FIG.  29.    The  muscles  that  move  the  eye.     for  too  long  a  time,  and  the  light 

should  be  good.  Another  fruit- 
ful cause  of  strain  is  reading  in  street  cars  or  other  places  where 
it  is  impossible  to  hold  the  page  still,  and  this  should  not  be  long 
continued  in  any  case.  Reading  in  bed  is  often  a  strain  on 
the  eyes,  not  because  the  position  of  the  body  affects  the 
eyesight,  but  because  most  persons  reading  in  bed  have  a  poor 
light  upon  the  book,  and  frequently  hold  the  book  in  an  awkward 
position,  so  that  it  strains  the  external  muscles  of  the  eyes  to 
keep  them  directed  on  the  page.  If  the  book  is  held  so  as  to 
be  directly  in  front  of  the  eyes  as  when  sitting,  and  the  light 
shines  over  the  shoulder  on  the  book,  reading  in  bed  is  not  par- 
ticularly injurious ;  but  most  bedrooms  are  so  arranged  that  the 
light  is  in  the  center  and  shines  directly  into  the  eyes  of  the  reader 
lying  in  bed.  Light  should  never  be  allowed  to  shine  directly  into 
the  eyes.  There  is  such  a  thing  as  too  much  light.  A  strong 
electric  light,  falling  on  the  book  in  such  a  way  as  to  make  the  page 
a  white  glare,  is  very  bad  for  the  eyes,  and  still  worse  is  the  cross- 
lighting  in  which  the  light  from  two  strong  lamps  at  once  falls  on 
the  book  from  different  directions. 

Most  people  can  remember  having  read  for  a  long  time  in  a  failing 
light  without  being  conscious  of  a  strain  upon  their  eyes,  and  then 
finding,  after  resting  the  eyes  for  even  a  minute,  that  they  could 
not  see  to  go  on.  In  such  a  case  the  eye  muscles  have  gradually  and 
with  increasing  effort  accommodated  themselves  to  the  strain  of 


The  Eyes  69 

focusing  the  eyes  upon  the  page,  in  a  light  growing  dimmer  and 
dimmer.  The  instant  that  they  are  relieved  after  such  a  strain 
they  relax,  allowing  the  eyes  to  return  to  their  normal  condition, 
in  which  reading  by  such  a  light  is  impossible.  The  effort  to 
resume  reading  after  the  reaction  subjects  these  muscles  to  a 
strain  which  is  felt  at  once. 

Other  ways  in  which  the  muscles  of  the  eye  are  overtaxed  is  by 
going  too  frequently  to  the  moving  pictures,  by  rapid  traveling 
in  automobiles  with  the  eyes  unprotected,  and  by  sticking  too 
closely  to  work  like  embroidery,  reading,  writing,  sewing,  or 
knitting,  without  giving  the  eyes  a  chance  to  rest.  Sewing  on 
black  stuff  is  especially  fatiguing  to  the  eyes. 

There  are  two  ways  of  relieving  such  a  strain,  if  the  taxing  occupa- 
tion is  a  necessity.  One  is  to  lift  the  eyes  from  the  work  as  of  ten  as 
possible  and  look  off  into  the  distance.  This  allows  the  muscles  to 
relax  and  rest.  The  other  is  to  accustom  oneself  as  far  as  possible 
to  work  by  the  sense  of  touch.  It  is  perfectly  possible  in  many 
occupations  to  do  the  work  well  without  using  the  eyes  half  the 
time.  Typewriting  is  now  taught  by  the  touch  system,  and  as 
every  one  knows,  an  experienced  knitter  can  knit  in  the  dark.  The 
strain  of  using  the  eyes  to  follow  the  motions  of  the  fingers  is  not 
only  bad  for  the  eyes  but  for  the  nervous  system,  which  directs 
the  eyes  and  receives  the  impulses  from  them. 

Symptoms  of  eyestrain.  We  are  constantly  receiving  signals 
from  the  eyes,  warning  us  of  overwork,  but  we  have  become  so  ac- 
customed to  this  condition  that  we  ignore  the  warning  even  when 
we  understand  exactly  what  it  means.  One  of  the  symptoms  of 
eyestrain  is  drowsiness.  If,  after  using  the  eyes  for  a  time,  one 
becomes  drowsy,  it  is  often  an  indication  of  fatigue  of  the  eye 
muscles.  Other  symptoms  are  twitching  of  the  eyelids,  or  a  heavy, 
peculiar  feeling  over  the  brows,  spots  before  the  eyes,  bloodshot 
eyes,  wrinkles  from  the  eyes  and  down  the  middle  of  the  fore- 
head, and  frequent  headaches. 

Besides  the  direct  symptoms  of  eyestrain,  there  are  various 


70  Personal  Hygiene  and  Home  Nursing 

reflex  symptoms.  Car  sickness  from  looking  out  of  car  windows, 
indigestion,  and  various  nervous  troubles  belong  to  this  class  of 
symptoms,  and  may  often  be  cured  by  putting  on  proper  glasses 
or  having  the  eyes  treated. 

So-called  "  wild  hairs,"  or  hairs  which  turn  into  the  eye,  are 
indications  of  inflammation  of  the  lids,  for  which  one  should  consult 
an  oculist.  Sties  are  caused  by  inflammation  of  the  lids,  and 
persistently  red  lids  should  be  treated. 

Defective  vision  in  children.  It  is  generally  believed  by  physi- 
cians that  at  least  one  fourth  of  the  school  children  of  this  country 
have  defective  vision.  In  numerous  cases  such  defects  are  not 
discovered  until  the  children  have  been  retarded,  mentally  and 
physically,  by  the  strain  undergone  by  the  brain  and  nervous  system 
in  the  effort  to  see  clearly.  Such  a  strain  may  cause  headache, 
fatigue,  nausea,  nervousness,  and  irritability;  and  in  addition  to 
this,  if  the  child  is,  like  many  children,  too  proud  to  admit  that  he 
does  not  see  well,  various  other  disadvantages  may  be  incurred. 
Since  the  eyes  of  a  child  are  used  constantly  at  school,  any  ocular 
defect  interferes  very  seriously  with  his  progress  in  education. 

Besides  the  difficulty  of  reading  easily,  defective  eyesight 
entails  a  great  strain  in  such  lines  of  work  as  handicrafts,  drawing, 
and  blackboard  work,  and  in  many  games.  Many  stupid  and 
backward  children,  and  even  many  insubordinate  children,  in 
schools  have  been  transformed  into  normal  pupils  after  being 
fitted  with  the  proper  glasses.  Children's  eyes  should  be  examined 
before  they  enter  school,  and  the  parents  should  keep  watch  to  see 
that  as  they  grow  older  the  children  do  not  engage  in  occupations 
tending  to  overtax  the  eyes.  It  is  to  be  hoped  that  some  day  all 
children  will  be  thoroughly  examined  physically  from  time  to  time, 
as  part  of  the  routine  of  their  school  life,  and  that  all  remediable 
defects  of  eyes,  nose,  throat,  or  other  parts  of  the  body  will  be 
corrected  early  in  life. 

Glasses.  The  fitting  of  glasses  is  skilled  work  and  should  be 
done  only  by  one  who  has  had  thorough  training  for  it.  A  good 


The  Eyes  71 

oculist  not  only  gives  the  prescription  of  his  glasses,  but  examines 
them  after  they  are  made,  that  there  may  be  no  mistake.  Do  not 
go  to  an  optician  for  glasses ;  to  do  so  is  like  going  to  a  druggist 
for  a  prescription.  Improper  glasses  often  cause  eyestrain  because 
they  are  too  strong  or  too  weak,  do  not  have  the  lens  centered 
exactly  in  front  of  the  eye,  or  in  some  other  way  do  not  fit  the  eye. 
Thus  the  eye  is  actually  worse  off  than  it  would  be  without  glasses. 

Treatment  of  the  eyes.  Few  accidents  of  a  minor  sort  are 
more  painful  than  cinders  or  specks  of  dust  in  the  eye.  If  when 
traveling  in  the  cars  one  feels  something  in  the  eye,  the  eye  should 
be  held  open,  that  the  secretion  of  tears  may  wash  the  object  out. 
If  the  eye  is  closed,  the  lid  holds  down  the  cinder  or  bit  of  dust  and 
presses  it  into  the  eyeball.  Rubbing  the  eye  is  the  very  worst 
thing  to  do  in  such  a  case.  Foreign  matter,  such  as  a  flaxseed  or 
an  "  eyestone,"  should  not  be  inserted  into  the  eye  to  remove  a 
speck.  It  is  occasionally  effective,  but  as  a  rule  it  tends  to  inflame 
it.  It  is  better  to  get  the  foreign  particle  out  by  washing  the  eye 
with  boric  acid  solution  or  wiping  the  offending  particle  out  with 
clean  gauze  or  a  handkerchief.  If  the  lid  is  drawn  back  over  a 
pencil,  the  speck  will  possibly  be  discovered. 

A  saturated  solution  of  boric  acid  can  be  used  freely  for  washing 
the  eyes,  and  if  the  eyes  are  strained  or  inflamed  it  is  soothing  and 
healing.  The  solution  should  be  carefully  prepared,  for  if  the 
powder  is  not  thoroughly  dissolved  it  may  irritate  the  surface 
of  the  eyeball ;  for  this  reason  it  is  best  to  have  it  prepared  at  a 
drug  store.  A  pipette  or  eye  dropper  can  be  used  for  injecting 
the  solution  into  the  eye,  and  this  pipette  should  be  used  for  no 
other  purpose,  or  the  eyes  may  be  washed  with  an  eye  cup,  which 
may  be  purchased  at  any  druggist's.  No  other  solution  should 
be  put  into  the  eyes  without  an  order  from  a  physician.  Witch 
hazel,  which  is  sometimes  used,  is  not  injurious  in  itself ;  but  it  is 
sometimes  prepared  with  wood  alcohol  instead  of  a  pure  grain 
alcohol,  and  wood  alcohol  is  most  injurious  to  the  eyes. 

When  drops  are  put  into  the  eye,  it  will  cause  much  less  pain  if 


72  Personal  Hygiene  and  Home  Nursing 

the  lid  is  pulled  down  and  the  drops  allowed  to  fall  on  the  edge  oi 
the  lid,  than  if  the  drops  fall  directly  into  the  eye.  If  the  drops 
are  to  remain  in  the  eye,  one  or  two  are  all  that  are  necessary,  as 
more  will  run  out.  In  taking  care  of  an  infected  eye  it  is  necessary 
to  be  very  careful,  as  most  such  diseases  are  highly  contagious. 
It  is  necessary  to  take  care,  not  only  to  keep  the  infection  from  being 
conveyed  to  the  eyes  of  another  person,  but  to  prevent  infection 
spreading  from  one  eye  of  the  patient  to  the  other.  A  fresh  piece 
of  cotton  should  be  used  for  each  eye  in  turn. 

Causes  of  eye  weakness  now  recognized  by  opticians  are  .  in- 
fections from  decayed  teeth,  diseased  tonsils,  or  chronic  colds  with 
infected  sinuses. 


CHAPTER  ELEVEN 


EFFECT  OF  POSTURE  ON  HEALTH  AND  EFFICIENCY 


FASHION  has  for  so  long  dic- 
tated the  shape  of  the  body  that 
many  persons  seem  to  have  for- 
gotten the  reasons  for  its  original 
form.  They  consider  it  only 
from  the  standpoint  of  beauty 
and  as  a  means  of  showing  off 
beautiful  clothes,  and,  strange  to 
say,  as  Dame  Fashion  dictates 
changes,  our  idea  of  beauty  of 
form  changes  also;  what  today 
we  consider  a  deformity,  next 
month  we  may  be  working  hard 
to  cultivate.  Many  persons 
seem  not  to  appreciate  the  real 
beauty  of  the  well-formed  body 
poised  as  it  should  be,  or  what 
the  effect  upon  the  health  is 
when  this  poise'  is  lost  and  the 
body  has  become  unshapely. 
This  lack  of  appreciation  no 
doubt  comes  largely  from  igno- 
rance of  the  real  purpose  of  the 
body,  of  the  wonder  and  beauty 
of  its  formation,  and  a  failure  to 
realize  how  by  carelessness  and 
lack  of  thought  this  wonderful 
machine  may  be  injured  and 
prevented  from  doing  its  perfect 
work.  That  my  readers  may 
have  a  better  knowledge  of  their 
bodies,  I  have  introduced  here  a 

73 


FIG.  30.  Poor  posture.  Knees  are  re- 
laxed, shoulders  stooped,  head  drooped 
forward ;  chest  is  flat,  abdominal  muscles 
relaxed.  The  weight  falls  back  of  the 
heels,  throwing  center  of  gravity  back  of 
body  support. 


74  Personal  Hygiene  and  Home  Nursing 

brief  description  of  the  human  body  and  a  discussion  of  the 
structure  and  proper  relations  of  some  of  its  organs  and  parts. 

The  human  body.  To  the  student  of  anatomy  and  physiology, 
the  body  is  the  most  wonderful  machine  in  the  world.  The  more 
he  studies  it  the  more  he  realizes  that  every  part  of  it,  no  matter 
how  small,  how  seemingly  unimportant,  has  its  own  special  func- 
tion or  work,  and  that  all  the  parts  together  make  up  a  wonderful 
whole,  built  for  the  greatest  efficiency.  Each  organ  is  a  complete 
unit  in  structure,  and  each  has  a  function  that  it- definitely  per- 
forms. Yet  all  the  organs  are  built  into  one  whole,  infinitely  more 
complex  in  both  structure  and  function  than  any  of  the  parts. 

The  framework  of  the  body.  There  are  in  the  body  over  two 
hundred  bones  of  many  different  shapes  and  sizes.  Where  strength 
is  needed,  the  bones  are  heavy.  Where  flexibility  is  desired,  they 
are  short  and  small  and  held  together  by  powerful  ligaments  and 
muscles.  Where  protection  is  the  chief  function,  the  bones  are 
flat  and  broad  like  the  bones  of  the  skull  which  inclose  and  protect 
the  brain. 

In  the  neck  and  in  the  back  of  the  trunk  is  a  chain  of  small  bones, 
called  the  vertebra.  Each  one  is  separated  from  the  next  by  small 
disks  of  soft,  compressible  cartilage  or  gristle,  and  they  are  held 
together  by  strong  ligaments  and  muscles.  All  together  they 
form  the  spinal  column,  which  stiffens  and  supports  the  body.  In 
the  middle  of  this  column  of  bones  is  a  canal  through  which  runs 
the  spinal  cord,  thoroughly  protected  by  the  walls  of  the  vertebrae. 
From  the  spinal  cord,  through  little  openings  in  the  vertebrae, 
nerves  go  out  to  all  parts  of  the  body.  The  spinal  column,  because 
of  the  shape  of  its  bones  and  the  softness  of  its  disks,  is  flexible, 
capable  of  being  bent  in  any  direction. 

The  flexibility  of  the  spinal  column  continues  largely  through 
life,  although  not  to  the  same  extent  in  an  adult  as  in  a  child ;  for 
through  the  years  of  childhood  the  disks  are  gradually  becoming 
hardened  and  are  taking  the  form  into  which  they  are  forced  by 
the  carriage  of  the  body.  In  the  properly  poised,  erect  body  the 


Effect  of  Posture  on  Health  and  Efficiency        75 


FIG.  31.    Poor  posture.    The  upper  part  FIG.  32.     Good  posture.    The  weight  is 

of  the  body  is  too  far  backward  and  the  well  forward,  chest  elevated,  shoulders 

weight  falls  on  the  heels.  free,  abdominal  and  waist  muscles  firm. 

disks  are  regular  in  shape,  and,  when  looked  at  from  the  back, 
the  vertebral  column  forms  a  straight  line  from  the  neck  to  the 
buttocks.  If  the  body  is  allowed  to  droop  forward  and  the 


Personal  Hygiene  and  Home  Nursing 


FIG.  33.  Bad  posture.  The  weight  is 
on  one  foot,  the  right  hip  high  and  the 
right  shoulder  low.  This  position  may 
result  in  spinal  curvature. 


FIG.  34.  Correct  posture.  The  weight 
is  on  both  feet,  and  the  hips  and 
shoulders  are  even.  Note  the  more 
pleasing  effect  as  a  whole. 


shoulders  and  hips  to  become  uneven,  —  one  high  and  one  low,  — 
there  is  an  uneven  pressure  put  upon  the  disks  between  the  verte- 
brae, which  causes  them  to  develop  unevenly  and  as  they  harden 
for  adult  life  to  become  wedge-shaped,  thin  on  one  edge  and  thick 
on  the  other.  Other  joints  in  the  body  also  are  influenced  by  the 


Effect  of  Posture  on  Health  and  Efficiency        77 

position  in  which  the  body  is  habitually  held,  and  as  all  bones  of 
the  body  become  harder  as  the  individual  reaches  adult  life,  the 
joints  become  set.  It  is  therefore  a  hard  and  tedious  matter  to 
change  the  way  the  bones  fit  together  and  the  carriage  of  the  body, 
after  adult  life  has  been  reached. 

Twelve  of  the  vertebrae  have  articulated  or  joined  to  them 
twenty-four  ribs,  twelve  on  each  side.  At  the  front  of  the  body 
the  ribs  are  joined  to  the  breastbone,  so  that  vertebrae,  ribs,  and 
breastbone  together  form  the  framework  of  the  chest.  The  bones 
of  the  shoulders  are  large  and  loosely  attached  for  strength  and 
flexibility.  Those  of  the  pelvis  are  firmly  united  for  strength, 
and  give  support  to  the  organs  within.  Attached  to  the  frame- 
work of  the  chest  are  many  muscles,  among  others  the  diaphragm, 
the  broad  muscle  which  separates  the  cavities  of  the  chest  and 
abdomen.  Within  the  cavity  inclosed  by  the  chest  walls  and  the 
diaphragm  are  the  lungs,  the  heart,  and  the  large  arteries  and 
veins. 

Arrangement  of  muscles.  There  are  five  hundred  muscles  in  the 
human  body.  They  are  arranged  in  antagonistic  groups  which 
work  in  opposition  to  each  other.  Every  group  of  muscles  has 
its  opposing  group,  and  these  groups  balance  each  other;  for 
example,  one  group  supports  the  back  when  leaning  forward, 
another  group  supports  the  front  of  the  body  when  leaning 
backward.  If  one  of  these  groups  becomes  weakened  from 
any  cause  such  as  paralysis,  strain,  or  lack  of  use,  it  no  longer 
pulls  evenly  against  its  antagonistic  group ;  these  unopposed 
muscles  then  overpull  and  cause  more  or  less  change  of  form 
in  the  body,  which  may  become  sufficiently  great  to  cause  a  real 
deformity. 

In  the  properly  poised  body  all  muscles  have  a  slight  tension. 
Each  group  of  antagonists  is  working  slightly,  holding  the  part 
they  move  poised  between  them,  so  that  movements  can  be  quickly 
and  easily  made.  Professor  W.  P.  Bowen,  in  his  book  on  Applied 
Anatomy  and  Kinesiology,  says : 


Personal  Hygiene  and  Home  Nursing 


FIG.  35.  Poor  posture  in  walking.  The 
toes  are  turned  outward  instead  of  point- 
ing straight  forward.  In  correct  walking 
the  heel  strikes  the  ground  first,  but  the 
weight  is  immediately  transferred  to  the 
ball  of  the  foot.  It  is  not  possible  to 
make  this  transfer  of  the  weight  unless 
the  toes  point  forward. 


"  Muscles  that  are  much  used 
are  apt  to  have  more  tone  than 
those  used  less ;  when  this  is  the 
case  between  two  antagonists, 
the  position  of  the  joint  upon 
which  they  act  is  apt  to  be  out 
of  normal  position  because  of  the 
greater  tension  of  the  one  most 
used.  Example :  Women's  elbows 
are  semi-flexed  because  extensors 
are  not  used.  Habitual  posture 
depends  much  on  muscular  tone, 
and  correction  of  posture  is 
secured  by  improving  the  tone 
of  one  muscle  and  stretching  its 
antagonist." 

Position  of  the  abdominal  or- 
gans. The  walls  of  the  abdomi- 
nal cavity  are  formed  by  the 
spinal  column,  the  upper  part  of 
the  pelvic  bones,  the  diaphragm, 
and  the  abdominal  muscles. 
When  the  body  is  held  erect,  the 
bones  and  muscles  form  ridges  or 
shelves  upon  which  the  abdomi- 
nal organs  rest.  They  are  held 
securely  upon  these  shelves  by 
ligaments,  fat,  and  the  pressure 
of  the  abdominal  muscles.  In  a 
faulty  posture  the  stooping  for- 
ward of  the  body  changes  the 
position  of  the  supporting  shelves 
and  relaxes  the  abdominal  mus- 
cles, and  the  abdominal  organs, 


Effect  of  Posture  on  Health  and  Efficiency        79 


lacking  support,  sag  down  from 
their  positions.  The  organs  in 
the  pelvis  lie  below  a  ridge 
formed  by  the  lumbar  vertebrae, 
the  pelvic  bones,  and  the  ab- 
dominal muscles.  When  the 
abdominal  organs  are  held  firmly 
in  place,  the  pelvic  organs  are 
protected  against  pressure  from 
above,  but  with  the  abdominal 
organs  out  of  place  the  pelvic 
organs  also  may  become  mis- 
placed. 

Correct  poise  in  standing.  In 
a  correct  standing  position  the 
feet  should  be  straight  or  almost 
straight  (i.e.,  toes  pointing  for- 
ward) ;  the  body  should  be 
swayed  forward  from  the  heel 
up  until  its  weight  rests  upon 
the  balls  of  the  feet;  the  head 
should  be  held  well  up  and  back, 
with  the  chin  rather  low;  the 
abdominal  and  knee  muscles 
should  be  tight,  and  the  body 
stretched  as  tall  as  possible. 
The  shoulders  should  not  be 
thrust  forcibly  back  but  be  held 
rather  relaxed,  for  if  the  body 
is  correctly  held  in  other  ways 
the  arms  and  shoulders  will  assume  the  positions  best  for  them. 

When  standing  relaxed  one  must  be  careful  not  to  let  the  body 
become  unbalanced,  one  shoulder  and  one  hip  high  and  the  spine 
twisted,  for  this  is  one  of  the  causes  of  curvature  of  the  spine.  If 


FIG.  36.  Correct  posture  in  walking. 
The  toes  are  pointed  straight  forward, 
making  easy  the  rhythmical  transference 
of  the  weight  from  heel  to  sole  in  pro- 
gressing forward. 


8o  Personal  Hygiene  and  Home  Nursing 


FIG.  37.  Bad  posture  in  walking.  The 
knees  are  relaxed,  the  shoulders  stooped, 
the  head  dropped  forward,  and  the  chest 
flat;  the  waist  and  abdominal  muscles 
are  relaxed. 


FIG.  38.  Correct  posture  in  walking. 
The  abdominal  and  waist  muscles  are 
contracted,  the  chest  .  elevated,  the 
shoulders  free,  and  the  weight  is  carried 
well  forward. 


the  shoulders  are  held  evenly  balanced  and  the  middle  line  of  the 
body  brought  over  the  supporting  leg  and  foot,  the  weight  of  the 


Effect  of  Posture  on  Health  and  Efficiency        81 


body  may  be  taken  off  the 
other  foot  and  leg  and  the 
foot  may  even  be  lifted  from 
the  floor  without  affecting 
the  balance  or  the  evenness 
of  the  shoulders  and  hips. 
Any  change  in  the  method 
of  using  the  body  is  difficult 
and  tiresome  at  first,  but  if 
persevered  in  the  muscles 
will  readjust  themselves  and 
the  correct  posture  will  be- 
come comfortable  and  the 
incorrect  one  tiresome. 

Correct  poise  in  sitting. 
When  one  is  sitting,  the 
body  should  be  well  back 
against  the  chair,  the  head 
up,  and  the  chin  in.  In  a 
properly  made  chair  it  is  pos- 
sible to  sit  erect  or  lean  back 
without  disturbing  the  correct  position  of  the  back  and  shoulders. 

Effect  of  posture  on  efficiency.  When  the  body  is  correctly 
poised  it  is  like  a  perfectly  balanced  machine,  for  all  its  parts  are 
so  adjusted  that  there  is  no  particular  strain  on  any  one  part. 
In  addition  to  this  the  circulation  is  not  interfered  with,  so  that 
organs,  muscles,  and  nerves  are  healthy  and  active.  The  lungs 
can  expand  naturally,  all  the  organs  have  room  to  do  their  work, 
the  muscles  are  ready,  the  brain  is  alert ;  and  it  is  a  known  fact 
that  those  whose  bodies  are  poised  aright  are  as  a  rule  more  healthy, 
can  move  more  quickly,  can  accomplish  more,  and  can  endure  much 
more  than  those  whose  bodies  are  imperfectly  poised. 

Causes  of  faulty  posture.  The  majority  of  children  are  born 
straight  and  continue  straight  throughout  the  first  years  of  their 


FIG.  39.  Bad  posture  in  sitting.  The  head 
is  thrust  forward  and  the  abdominal  organs 
are  crowded  together,  preventing  a  free  circu- 
lation of  the  blood  and  lymph  through  them. 


82 


Personal  Hygienp  and  Home  Nursing 


lives.  Frequently  the  first 
cause  of  incorrect  posture  is 
the  improper  hanging  of  the 
clothes.  Children's  clothing 
weighs  from  three  to  five 
pounds,  and  to  this  weight 
is  added  the  pull  of  the 
garters  supporting  the  stock- 
ings, which  are  often  so 
fastened  that  the  full  weight 
comes  on  the  movable 
shoulders.  Such  a  weight 
carried  for  a  short  while 
means  nothing;  but,  when 
carried  all  day  on  the  flexible 
shoulders,  it  gradually  causes 
them  to  bend  forward.  The 
supporting  underbodies  which 
carry  most  of  the  weight  of 
the  clothing  and  to  which 

the  garters  are  attached  should  be  cut  to  fit  close  about  the  neck, 
so  that  the  strong  muscles  and  less  movable  collar  bone  in  that 
region,  and  not  the  flexible  bones  at  the  points  of  the  shoulders, 
may  support  the  weight. 

Another  cause  of  faulty  posture  is  the  lack  of  suitable  chairs 
for  children  in  most  homes.  After  the  days  of  infancy,  the  growing 
boy  and  girl  are  forced  to  use  the  chairs  made  for  an  adult.  Not 
being  able  to  sit  back  on  the  chair  and  at  the  same  time  touch 
the  floor  with  the  feet,  they  sit  forward  on  the  seat,  reaching  with 
the  toes  to  the  floor.  If  they  wish  to  lean  back,  they  lean  with  the 
upper  part  of  the  back  touching  the  chair,  and  then  lean  the  head 
forward  to  see  to  read.  This  position  on  the  chair  thrusts  the 
shoulders  forward  and  straightens  out  the  natural  curve  of  the 
spinal  column  in  the  lumbar  region,  and  it  becomes  such  a  habit 


FIG.  40.    Correct  posture  in  sitting. 


Effect  of  Posture  on  Health  and  Efficiency        83 

that  often,  later  in  life,  when  grown  to  manhood  and  womanhood, 
the  person  continues  to  sit  in  this  way. 

Some  few  years  ago  there  was  a  great  outcry  against  the  desks 
used  in  schools.  People  recognized  the  fact  that,  in  a  class  formed 
of  children  of  different  sizes,  one  size  of  desks  could  not  fit  all,  and 
so  adjustable  desks  and  chairs  were  made.  These  chairs,  how- 
ever, are  so  hard  to  adjust  that  the  ordinary  woman  teacher  is 
not  equal  to  the  task,  even  if  she  thinks  of  undertaking  it ;  and 
frequently  no  attempt  is  made  to  fit  them  to  the  height  of  the 
child.  I  have  been  told  by  teachers  that  they  have  taught  in 
schoolrooms  for  months  before  they  knew  that  the  chairs  and 
desks  were  adjustable,  and  that  they  had  never  seen  any  attempt 
made  to  regulate  their  height.  If  parents  would  insist  upon  the 
proper  adjustment  of  desks,  round  shoulders  would  be  much  less 
common  among  children. 

Another  cause  of  round  shoulders  is  the  heavy  bag  of  books 
which  is  carried  to  and  from  school,  many  of  the  books  not  used 
daily.  With  a  little  attention  on  the  part  of  teacher  and  parents, 
the  number  of  books  used  could  be  decreased  or  duplicate  books 
for  home  use  could  be  supplied. 

In  adults,  faulty  posture  comes  frequently  from  deliberately 
carrying  the  body  improperly,  because  of  fashion ;  to  accommo- 
dating the  body  to  clothes  which  are  fashionable  at  the  time ;  to 
sitting,  standing,  and  walking  incorrectly ;  and  to  wearing  im- 
proper corsets  and  shoes.  Postures  assumed  daily  during  work 
also,  in  many  cases,  change  the  shape  of  the  body. 

Results  of  improper  posture.  One  result  of  improper  posture  is 
fatigue.  The  body  is  a  delicately  balanced  mechanism.  Any 
change  in  its  balance  which  forces  one  group  of  muscles  to  sup- 
port more  weight  than  its  antagonistic  group,  causes  strain,  and 
as  all  parts  of  the  body  are  so  closely  related,  no  one  part  can  be 
strained  without  affecting  the  whole.  When  the  body  is  properly 
balanced,  with  each  muscle  working  as  it  should,  not  only  is  less 
energy  required  for  holding  the  position,  but  all  changes  from 


84  Personal  Hygiene  and  Home  Nursing 

the  position  are  more  easily  made.  In  addition  to  this  a  correct 
posture  allows  the  blood  to  circulate  freely,  and  puts  no  undue 
pressure  on  the  nerves.  But  when  the  body  is  improperly  bal- 
anced, its  work  is  done  with  constant  strain  and  fatigue. 

One  case  which  came  under  my  notice  was  that  of  a  young 
woman,  an  enthusiastic  art  student,  who  suffered  constantly  from 
pain  in  her  side  and  could  not  continue  her  studies  because  of 
excessive  fatigue.  She  had  been  treated  by  first  one,  then  another 
physician,  and  finally  a  doctor  whom  she  consulted  diagnosed  her 
case  as  one  of  general  ptosis  or  sinking  of  the  abdominal  organs. 
To  verify  his  diagnosis,  the  physician  sent  her  to  have  an  X-ray 
taken  of  her  digestive  organs,  and  it  was  then  that  I  saw  her  wait- 
ing to  learn  the  result  of  her  examination.  I  have  never  seen  a 
more  hopeless  look  on  any  one's  face.  When  I  suggested  that  the 
trouble  might  not  prove  to  be  as  serious  as  she  seemed  to  fear,  she 
broke  out  with :  "  You  don't  understand  a  thing  about  it.  I 
have  not  been  well  for  two  or  three  years,  am  tired  all  the  time,  am 
constipated,  and  constantly  suffer  from  indigestion.  Every  one 
tells  me  it  is  nerves  and  advises  me  to  get  something  useful  to  do, 
when  I'm  crazy  to  go  on  with  my  studies,  and  I'm  just  afraid  that 
they  will  tell  me  again  that  there's  nothing  wrong.  I  want  them 
to  find  something  wrong,  so  that  it  can  be  cured  and  I  can  get 
well." 

They  did  find  something  wrong ;  for  the  X-ray  showed  that  her 
stomach  and  part  of  her  large  intestine  were  in  the  lowest  part  of 
her  abdomen,  instead  of  in  the  highest  part,  where  they  belonged. 
She  was  given  no  medicine  at  all,  only  rest  and  fattening  food 
at  first,  and  then  later  the  proper  exercises  to  return  her  organs 
to  their  proper  position,  —  exercises  that  would  correct  her  poise 
and  strengthen  her  abdominal  muscles  so  that  the  organs  would 
be  held  in  place.  Later  a  second  X-ray  was  taken  which  showed 
her  stomach  and  intestines  in  normal  position,  and  today  she  is  a 
splendidly  healthy  woman,  enthusiastic  over  her  work,  with  no 
pain  and  only  a  normal  amount  of  fatigue. 


Effect  of  Posture  on  Health  and  Efficiency        85 

A  second  result  of  faulty  use  of  the  body  is  pain.  Many  cases  of 
neuritis  in  different  parts  of  the  body  are  caused  by  improper 
poise  and  improper  pressure  upon  muscles  and  nerves.  For  ex- 
ample, it  is  now  believed  that  sciatica  comes  from  a  slight  dis- 
location at  the  articulation  of  the  lower  part  of  the  spinal  column 
(the  sacrum)  and  the  pelvic  bone,  causing  pressure  on  the  sciatic 
nerve.  The  same  trouble  may  cause  lumbago.  Many  physicians 
believe  that  writer's  cramp  and  other  pains  in  the  hands  and  arms 
are  caused  by  improper  positions  or  straining  of  the  muscles  and 
nerves  of  the  arm  and  shoulder.  Pain  in  the  sides  and  abdomen 
is  caused  by  the  dragging  down  of.  the  organs  and  the  interference 
with  perfect  circulation.  Frequently  pain  is  caused  through  the 
menstrual  period  by  pressure  downward  upon  the  organs  or  by 
strain  upon  the  back  due  to  improper  posture. 

A  third  common  result  of  improper  posture  is  constipation  and 
indigestion.  When  the  abdominal  muscles  are  relaxed  and  the 
abdominal  organs  are  sagging  down  and  pressing  upon  each  other, 
not  only  is  the  free  circulation  of  blood  prevented  but  there  may 
be  a  mechanical  interference  with  the  passage  of  food  from  the 
stomach  into  the  intestine.  This,  particularly  in  children,  is 
frequently  followed  by  indigestion,  accompanied  by  nausea  and 
vomiting  recurring  at  regular  intervals,  and  results  in  imperfect 
nourishment  of  the  body.  Interference  with  the  free  movement 
of  the  material  in  the  large  intestine  is  followed  by  constipation. 

Two  nurses  whom  I  knew,  both  constipated,  thin,  nervous,  and 
tired  all  the  time,  one  hardly  able  to  finish  her  training,  the  other 
a  graduate  nurse  who  felt  that  she  must  give  up  her  position,  were 
helped  so  much  by  being  taught  to  use  their  bodies  as  they  should 
that  they  continued  their  work  with  interest  and  vigor.  Any 
one  who  has  worked  with  these  cases  either  as  physician  or  gym- 
nasium instructor  could  give  numbers  of  cases  where  the  beneficial 
results  that  follow  a  correction  of  the  posture  has  been  apparent. 

The  care  of  the  feet.  As  foot  troubles  and  incorrect  use  of  the 
feet  are  frequently  found  associated  with  faulty  posture  and  are 


86  Personal  Hygiene  and  Home  Nursing 

mentioned  by  some  authorities  as  causes  of  faulty  posture,  it 
seems  appropriate  to  include  in  this  chapter  something  in  regard 
to  the  feet  and  their  care.  There  is  no  part  of  the  body  that  be- 
comes more  out  of  shape  from  improper  use  and  treatment  than 
the  foot,  and  great  inconvenience,  pain,  and  nervousness  are  often 
caused  by  foot  troubles  that  could  have  been  avoided  with  a  little 
care. 

The  infant's  foot  is  straight,  almost  what  we  call  pigeon-toed. 
Each  toe  is  as  separate  as  the  fingers.  In  walking,  the  foot  is 
pressed  well  down,  the  toes  grasp  the  floor,  each  muscle  in  the 
foot  is  working.  Compare  with  this  the  foot  of  many  adults,  with 
the  toes  misshapen  and  overlapping ;  the  big  toe  frequently  forced 
under  the  other  toes ;  the  large  joint  swelled  at  the  side ;  the  arches 
flattened ;  and  corns  and  calluses  where  there  has  been  too  great 
pressure  from  the  shoe. 

Flat  foot  is  very  uncomfortable,  and  in  some  cases  there  is  the 
most  severe  pain.  It  is  due  to  several  causes :  to  improper  shoes ; 
to  constantly  standing  on  the  feet,  as  in  the  case  of  nurses  and 
policemen ;  to  turning  the  toes  out  in  walking,  thus  throwing  the 
weight  on  the  wrong  part  of  the  foot ;  to  an  excessive  amount  of 
weight ;  to  jumping 'in  games ;  to  being  on  the  feet  too  much  after 
illness;  and  to  a  general  condition  of  ill  health  and  muscular 
weakness.  It  is  a  condition  which  can  be  helped,  if  not  cured,  by 
treatment.  Leather  supports  are  better  than  steel,  but  braces 
should  be  used  only  temporarily  as  a  means  of  giving  relief,  while 
the  muscles  of  the  feet  are  being  strengthened  by  exercises  and 
stimulating  baths.  If  the  shoes  worn  are  not  of  the  correct  shape, 
they  must  be  changed. 

Bunions  are  irritated  joints  which  have  been  rubbed  by  shoes. 
They  accompany  a  flattened  anterior  arch  and  a  misplaced  great 
toe  which  has  been  pushed  out  of  the  natural  straight  line  by 
narrow,  short  shoes.  Much  can  be  done  to  relieve  the  pain  in 
inflamed  bunions  by  protecting  them  through  the  day  with  a 
plaster  or  with  two  or  three  layers  of  adhesive  plaster  with  holes 


Effect  of  Posture  on  Health  and  Efficiency        87 

cut  in  them  large  enough  to  encircle  the  joint,  and  by  applying 
ichthyol  salve  (4  per  cent)  at  night. 

For  acute  pain  in  the  anterior  arch  of  the  foot,  a  two-inch  strip 
of  adhesive  plaster  can  be  put  around  the  foot  just  below  the  joints 
of  the  great  and  little  toes  and  the  foot.  One  end  of  the  plaster 
should  be  fastened  to  the  top  of  the  foot  near  to  but  not  quite  in 
the  middle ;  bring  it  down  over  the  instep,  under  the  foot,  and 
up  the  other  side  of  the  foot,  and  fasten  the  second  end  near  the 
first  end  but  not  quite  meeting  it.  A  plaster  put  on  in  this  way 
forces  the  great  toe  slightly  out  towards  the  median  line  and 
gives  support  to  the  anterior  arch.  If  the  foot  is  to  be  used 
very  much,  put  a  second  strip  over  the  first  one  to  give  extra 
support. 


CHAPTER   TWELVE 

EXERCISE  AND   EXERCISES 

WE  make  a  distinction  between  exercise  and  exercises  in  this 
way :  Exercise  is  what  we  do  in  our  daily  life,  —  walking  and 
running,  working  with  the  hands,  and  all  the  movements  of  life,  — 
while  exercises  are  regulated  movements  that  are  made  to  accom- 
plish a  special  purpose,  to  develop  a  set  of  muscles  or  correct  a 
deformity. 

Exercise.  Exercise  begins  at  babyhood.  The  first  thing  a  baby 
does  is  to  cry  and  begin  to  kick  his  legs  and  arms ;  and  as  the  days 
go  on  the  baby  grows,t  cries,  and  exercises  his  lungs,  moves  his 
arms,  and  kicks,  and  helps  himself  to  develop  and  grow.  Later 
he  walks  and  runs  and  is  constantly  on  the  move.  A  growing 
child  will  run  and  walk  as  much  as  an  adult  and  sometimes,  we 
think,  more.  Frequently,  in  trying  to  follow  and  keep  up  with 
a  child,  an  adult  becomes  fatigued  while  the  child  is  still  fresh. 
This  exercise  is  necessary  for  the  child,  to  help  it  to  grow,  to  exercise 
its  muscles,  to  make  it  breathe  correctly,  and  to  keep  its  blood 
circulating.  As  the  boy  and  girl  grow  older,  they  begin  to  play 
games,  running  and  throwing  a  ball,  and  engaging  in  exercise  of 
all  sorts.  During  the  school  days  and  college  days,  these  exercises 
are  kept  up  for  both  boys  and  girls,  less  distinction  being  made 
today  than  in  former  years,  between  the  activities  of  the  boy  and 
of  the  girl. 

When  a  girl  leaves  college  there  is  still  the  same  necessity  for 
exercise,  and  the  healthy  girl  should  play  tennis,  golf,  and  other 
games,  and,  if  possible,  ride.  She  should  systematically  walk  — 
rapidly,  not  loafing  along  —  at  least  once  a  day.  Many  girls, 
upon  leaving  college,  give  up  practically  all  outdoor  life  and  un- 
consciously begin  to  allow  their  bodies  to  weaken  from  lack  of 
use.  Exercise  should  be  taken  daily  in  the  fresh  air.  Indoor 
games,  exercise  in  the  gymnasium,  or  work  in  the  house  should 
never,  except  from  the  sheerest  necessity,  be  substituted  for  out- 
door exercise  or  sports. 

88 


Exercise  and  Exercises  89 

Exercises.  If  one  or  more  muscles  are  weak  and  the  body  has 
become  deformed  or  weakened,  a  course  of  exercises  aimed  directly 
at  the  remedying  of  the  defect  should  be  taken.  In  this  chapter  no 
attempt  will  be  made  to  give  a  set  of  exercises  for  the  overcoming 
of  certain  bodily  defects ;  for  ordinarily  exercises  can  be  made  to 
accomplish  their  purposes  only  when  individual  work  is  taken 
under  the  personal  direction  of  an  instructor.  The  purpose  of 
the  chapter  is,  rather,  to  emphasize  the  importance  of  corrective 
exercises  for  certain  troubles  and  to  explain  why  these  are  seldom 
carried  out  successfully  in  class  exercises  or  by  correspondence. 

Difficulty  of  correcting  defects  by  group  exercises.  In  a  large 
classroom,  it  is  impossible  for  the  teacher  to  give  such  direct  in- 
dividual attention  as  is  necessary  to  correct  a  deformity.  In  giving 
an  exercise  to  a  class,  the  instructor  gives  that  exercise  exactly  as 
it  should  be  done,  but  if,  through  inattention  or  because  of  not 
realizing  the  importance  of  the  technique  of  the  exercise,  the  student 
is  careless  in  her  work,  she  will  not  get  the  development  from  the 
exercise  that  she  should.  Stooped  shoulders  or  some  slight  fault 
in  posture  can  be  corrected  perfectly  in  a  large  class,  by  paying 
attention  to  the  details  of  the  work ;  but  the  strictest  attention  is 
required,  because  when  doing  an  exercise  even  a  slight  deviation 
from  the  proper  position  of  arms,  head,  or  other  parts  of  the  body 
will  affect  the  work  of  a  given  muscle.  For  instance,  in  an  exercise 
with  the  arms,  if  strict  attention  is  not  paid  to  the  line  upon  which 
the  arms  are  to  be  held,  the  muscles  will  not,  in  that  exercise,  be 
used  as  they  were  originally  intended  to  be.  When  the  deformity 
is  such  that  more  complex  exercises  are  required  for  its  correction, 
even  the  attentive  student  is  likely  to  make  some  error  in  carrying 
out  the  details  of  the  exercise,  and  the  assistance  of  the  instructor  is 
a  necessity. 

Why  taking  exercises  by  correspondence  is  unsatisfactory. 
Taking  exercises  by  correspondence  is  unsatisfactory  because  of 
the  difficulty  of  following  out  correctly  the  technique  of  an  exercise 
that  has  not  been  seen.  I  have  known  persons  who  have  worked 


go  Personal  Hygiene  and  Home  Nursing 

for  months  trying  to  correct  some  particular  weakness  by  taking 
exercises  obtained  through  a  correspondence  course  and  who,  at  the 
end  of  that  time,  found  themselves  in  the  same  condition  as  when 
they  began,  or  worse.  After  these  persons  had  used  the  same 
exercises  under  an  instructor,  they  were  able  to  develop  the 
weakened  muscles.  If  one  attempts  to  use  exercises  without  the 
personal  help  of  a  teacher,  she  should  do  them  in  front  of  a  mirror. 
Here  she  should  study  out  slowly  and  in  detail  each  movement,  and, 
after  mastering  the  technique,  continue  to  use  the  mirror.  In  this 
way  she  may,  to  a  certain  extent,  overcome  the  handicap  of  work- 
ing alone;  but  it  is  the  very  exceptional  student  who  can  work 
satisfactorily  in  this  way. 

Danger  of  continuing  an  exercise  too  long.  Another  reason  for 
the  competent  oversight  of  corrective  exercises  is  that,  frequently, 
after  a  course  of  exercises  directed  to  strengthen  one  muscle  has 
been  described  and  used  during  a  certain  period,  the  time  comes 
when  the  exercise  should  be  changed  because  that  muscle  has 
reached  its  normal  development.  The  student  working  without 
guidance  may  not  realize  this  and  the  exercise  may  be  continued 
until  the  muscle  becomes  as  much  too  strong  as  it  had  been  too 
weak  previously,  and  so  another  deformity  may  be  started. 

The  use  of  braces  in  cases  of  defects.  In  some  cases  braces 
are  absolutely  necessary  for  shoulders,  feet,  or  any  part  of  the 
body  that  may  be  out  of  position.  These  braces  should  always  be 
given  by  a  physician  who  has  studied  this  work  thoroughly,  and, 
except  in  extreme  cases,  they  should  never  be  used  unless  they  are 
sometimes  removed  and  exercises  taken.  They  give  support  to 
the  body,  but  they  do  not  exercise  the  muscles ;  and  a  brace  that  is 
constantly  worn  (particularly  under  the  arch  of  the  foot)  without 
the  proper  exercise,  may  cause  a  wasting  away  of  the  muscles 
whose  movements  they  are  hampering. 


CHAPTER   THIRTEEN 
GENERAL  HOME  NURSING 

WHILE  certain  cases  of  illness  can  best  be  cared  for  in  the  hos- 
pital, with  all  its  equipment  and  appliances,  and  while  in  other 
cases  the  presence  of  a  trained  nurse  is  necessary  if  the  patient  is 
to  receive  proper  care,  yet  there  are  occasions  when  neither  the 
hospital  nor  the  trained  nurse  is  available,  and  the  nursing  must 
be  done  by  members  of  the  family,  at  home.  It  is  of  the  greatest 
importance  at  such  times  to  know  how  best  to  arrange  for  the 
comfort  of  the  patient  and  to  administer  the  treatment  that  the 
physician  orders.  Even  when  a  trained  nurse  is  employed,  the 
more  the  members  of  the  family  understand  of  her  work  and  its 
conditions,  and  the  more  they  are  able  to  do  to  help  her,  the  greater 
is  the  patient's  chance  of  a  quick  and  satisfactory  recovery. 

In  every  family,  moreover,  emergencies  arise  when  everything 
that  any  one  in  the  family  knows  about  illness  will  prove  of  value, 
and  when  these  emergencies  come  there  is  no  time  to  learn  what 
is  best  to  be  done.  The  sick  room  is  no  place  for  guesswork  or 
experiment,  and  unfortunately  much  of  the  volunteer  services 
and  advice  received  at  these  critical  times  is  from  the  kind  of 
experts  who  "  might  better  not  know  so  much  than  to  know  so 
many  things  that  are  not  so."  Experience  without  co*mmon 
sense  and  the  right  kind  of  information  is  worse  than  useless,  and 
a  girl  will  often  find  a  sound  training  in  the  simple  principles  of 
nursing  invaluable  in  her  own  home. 

The  place  for  the  patient.  The  first  matter  to  be  decided  in 
any  case  of  illness  is  the  room  in  which  the  patient  is  to  stay. 
Sometimes,  of  course,  it  is  necessary  to  use  the  patient's  own 
room,  but  it  may  be  possible  to  choose  another  which  can  be 
cleared  of  unnecessary  furniture  with  comparatively  little  trouble 
and  which  will  be  more  desirable.  The  room  should  be  large  and 
easily  ventilated,  and  if  possible  should  be  on  a  floor  with  a 
bathroom.  It  should  be  in  as  quiet  a  part  of  the  house  as  can  be 
chosen,  and  if  it  contains  a  fireplace  it  will  be  all  the  better. 

91 


Personal  Hygiene  and  Home  Nursing 


FIG.  41.    When  the  sick  room  is  arranged,  everything  not  needed  in 
it  should  be  cleared  out  at  once. 

The  open  fire  not  only  gives  better  ventilation,  but  affords  an 
easy  means  of  destroying  waste,  whether  infectious  or  not. 

The  walls  of  the  room  chosen  for  the  patient  should  be  plain 
in  effect,  and  certainly  not  covered  with  large-flowered  or  gayly 
decorated  paper.  Any  one  who  has  been  ill  in  a  room  with  flowered 
paper  is  likely  to  remember  the  weary  hours  spent  in  counting 
the  figures  and  following  the  pattern  in  spite  of  oneself.  Plain 
plaster  or  calcimine  finish  in  a  soft  color  is  good,  and  next  best 
is  a  plain  paper  or  one  with  a  figure  so  small  that  it  gives  the  effect 
of  plain  paper.  If  one  must  prepare  walls  inexpensively  and 
quickly,  the  glaring  white  of  a  whitewashed  wall  can  be  avoided 
by  mixing  a  little  tinting  matter  such  as  ocher  with  the  whitewash 
to  make  a  soft  buff  or  other  color.  Pictures  and  ornaments  should 
be  either  removed  altogether  or  chosen  with  the  absolute  certainty 
that  they  will  not  worry  the  patient.  In  delirium,  pictures  and 
ornaments  often  seem  to  take  peculiar  forms  and  increase  the 
excitement.  Even  a  very  beautiful  picture  becomes  tiresome  and 
irritating  to  a  nervous  invalid,  when  looked  at  day  after  day. 

A  dark  room,  unless  absolutely  required  by  the  physician's 
orders,  is  not  best,  especially  in  the  case  of  a  nervous  patient.  If 


General  Home  Nursing  93 

the  bed  does  not  face  the  window,  the  shades  and  windows  may 
be  left  open,  and  if  the  light  is  too  bright,  the  eyes  may  be  shielded 
by  a  screen.  The  bed  should  always  be  placed  so  that  the  patient 
will  not  face  the  light.  It  often  serves  to  increase  delirium  to  have 
the  light  shining  constantly  in  one's  face.  Even  when  a  shade  is 
drawn,  the  little  crack  of  light  shining  through  beside  or  under  it 
is  tiring  to  the  eyes. 

In  a  long  illness,  the  position  of  the  bed  may  occasionally  be 
changed,  and  also  the  position  of  the  furniture.  A  small  change 
in  the  arrangement  of  a  sick  room  is  an  event.  Monotony  may 
be  prevented  by  changing  the  pictures  and  ornaments  now  and 
then,  and  a  growing  plant  is  a  source  of  interest  as  it  blossoms 
from  day  to  day. 

The  one  great  fact  in  the  psychology  of  the  sick  room  is  that 
for  the  time  being  the  patient,  like  a  child,  finds  little  things  most 
important.  The  wise  nurse  will  avoid  "  nagging  "  the  patient 
by  asking  unnecessary  questions  or  making  comments,  but  will 
quietly  make  some  little  change  now  and  then  without  remark, 
and  see  to  it  that  there  is  some  occupation  for  the  patient's  atten- 
tion aside  from  watching  the  sun  crawl  along  the  carpet.  When 
the  sick  room  is  arranged,  if  everything  not  needed  is  cleared  out 
of  it  at  once,  it  will  not  only  make  the  care  of  the  patient  much 
easier  but  will  avoid  the  fatigue  which  comes  of  watching  some 
one  day  after  day  in  the  same  round  of  "  tidying  up." 

Keeping  records  and  charts.  Records  should  be  kept  from  the 
beginning  of  an  illness.  It  is  really  a  simple  task.  All  instru- 
ment dealers,  and  many  drug-store  proprietors,  keep  on  sale 
record  blanks  and  temperature  charts.  Temperature  charts  are 
easy  to  read  and  simple  to  keep.  They  are  marked  exactly  as 
are  thermometers,  so  that  any  one  who  can  read  a  thermometer 
can  keep  a  chart.  On  the  record  should  be  noted  not  only  the 
temperature,  pulse,  and  respiration,  but  the  amount  of  sleep,  the 
amount  of  food  taken,  the  excretions,  their  number  and  descrip- 
tion, and  many  other  facts  which  enable  the  doctor  to  keep  up  with 


94  Personal  Hygiene  and  Home  Nursing 


Form  «* 
Mirtr.i,  nrr»Tn>iT  It  §  AWT 

BEDSIDE  NOTES 

Name                                                                   Rank                      Co                        Ru 

.  or  Staff  Corps 

• 

» 

- 

1 

I 

1 

| 

1 

1 

i  "  _  i  _j  

1 

FIG.  42.     Form  for  bedside  notes  used  in  United  States  Army  hospitals.    The  temper- 
ature, pulse,  and  respiration  are  shown  by  graphs  on  another  sheet  (see  page  167). 


General  Home  Nursing  95 

the  case.  The  more  accurate  and  detailed  his  information,  the 
more  certainly  he  will  be  able  to  judge  of  the  demands  of  the  case. 
A  physician  sometimes  finds  after  days  of  fever  that  the  tempera- 
ture has  been  recorded,  if  recorded  at  all,  on  little,  undated  scraps 
of  paper,  and  if  he  cannot  know  on  what  day  of  the  disease  the 
temperature  has  been  taken  it  seriously  interferes  with  his  inter- 
pretation of  the  symptoms. 

The  doctor's  orders.  Always  carry  out  the  doctor's  orders 
absolutely.  If  an  order  is  not  clearly  understood,  ask  the  doctor 
to  explain  it  before  he  leaves  the  house.  Any  physician  would 
rather  be  asked  two  or  three  times  for  further  explanation,  than  to 
come  back  and  find  that  his  orders  have  not  been  carried  out 
because  they  have  not  been  understood.  It  occasionally  happens 
that  the  physician  or  nurse  in  charge  of  a  case,  in  leaving  the 
untrained  home  nurse  in  charge,  takes  it  for  granted  that  she 
knows  something  she  does  not  know,  or  that  she  is  capable  of 
dealing  with  certain  situations  with  which  she  has  had  no  ex- 
perience. In  that  case  the  home  nurse  should  ask  questions,  and 
make  sure  that  she  thoroughly  understands  the  matter  before 
she  takes  the  responsibility.  Any  trained  worker  is  only  too  glad 
under  such  circumstances  to  explain  to  a  willing  but  inexperienced 
helper. 

Regularity  in  giving  food  and  medicines.  Food  and  medicines 
must  be  prepared  and  given  exactly  when  ordered.  Medicines 
must  be  measured  accurately,  and  be  ready  on  the  moment.  Food 
must  be  ready  to  serve  at  the  time  when  it  is  to  be  given,  and  even 
a  little  before.  Delay  in  giving  a  medicine,  or  fifteen  or  twenty 
minutes'  delay  in  a  meal,  has  been  known  to  cause  serious  loss 
to  the  patient  through  weakness.  Amateur  nurses  sometimes 
wait  to  begin  their  preparations  until  the  hour  of  the  meal,  and 
even  remark  that  they  must  go  down  and  see  about  the  patient's 
tray,  leaving  the  patient  to  wait,  as  it  seems,  an  indefinitely  long 
time  for  the  food.  In  preparing  food,  the  nurse  should  have  her 
mind  made  up  early  what  she  will  give  at  the  next  meal,  and  how 


96  Personal  Hygiene  and  Home  Nursing 

long  it  will  take  to  prepare  it,  and  all  the  essentials  should  be  got 
ready  beforehand.  She  should  know  how  long  the  immediate 
preparation  will  take,  and  begin  in  time,  —  not  wait  until  ten 
or  fifteen  minutes  before  the  hour  to  begin,  and  try  to  make  up 
the  time  by  hurrying. 

Care  of  the  sick  room.  In  the  case  of  an  infectious  disease,  all 
wastes  that  can  be  burned  should  be  so  destroyed  in  the  fireplace, 
if  there  is  one.  In  sweeping  the  room,  dust  should  be  avoided  as 
far  as  possible.  The  floor  can  be  wiped  with  a  floor  mop,  and  the 
furniture  with  a  lightly  oiled  cloth.  Everything  that  is  soiled 
should  be  removed  and  cleaned  at  the  earliest  practicable  moment. 

Watching  and  measuring  the  excreta.  Watch  the  urine  and 
bowel  discharges,  and  all  expectorations  or  other  excretions. 
Urine  should  be  measured,  and  no  bed  pan  should  be  emptied 
without  thorough  examination.  The  physician  is  often  warned 
of  some  trouble  from  the  condition  of  the  urine  or  feces.  If,  when 
emptying  a  bed  pan,  there  is  anything  unusual  in  the  appearance 
of  the  contents,  they  should  be  saved  and  shown  to  the  physician. 
It  is  better  to  save  specimens  unnecessarily  several  times,  than  to 
throw  out  one  which  might  have  indicated  danger.  In  some 
diseases,  particularly  typhoid  fever,  hemorrhage  will  show  in  the 
excretions  of  the  bowels.  The  untrained  eye  may  fail  to  recog- 
nize blood  in  this  case,  because  when  it  comes  from  high  in  the 
intestine  it  is  brown  and  not  red,  but  the  trained  physician  recog- 
nizes it  at  once. 

Etiquette  of  the  sick  room.  Never  whisper  in  the  room  of  a 
patient.  If  anything  must  be  said  which  is  not  to  be  heard  there, 
go  quite  away.  Nothing  is  more  exciting  or  annoying  than  the 
sound  of  whispering  to  a  nervous  patient.  She  imagines  that  she 
is  dying,  that  some  secret  is  kept  from  her,  that  things  are  going 
on  in  the  family  which  she  is  not  to  know,  and  even  when  she  really 
knows  that  nothing  is  the  matter  she  cannot  help  these  worrying 
fancies.  If  it  is  necessary  to  talk  in  the  sick  room,  speak  so  that 
the  patient  can  hear  easily.  Of  course,  if  she  is  sleeping,  you  will 


General  Home  Nursing  97 

not  speak  in  the  room  at  all.  Do  not  whisper  outside  the  door 
or  in  the  hall.  Go  quite  away  to  do  any  talking  that  must  be  done. 

If  it  is  necessary  to  make  a  report  to  the  physician,  go  out  of 
the  room  to  do  so.  It  is  an  excellent  plan  to  make  a  habit  of  fol- 
lowing the  physician  to  the  door,  whether  there  is  anything  to 
report  or  not,  so  that  the  patient,  being  accustomed  to  this  as  a 
part  of  the  routine,  will  not  become  uneasy  when  there  really  is 
reason  for  consultation.  Some  doctors  arrange  to  have  the  nurse 
go  out  of  the  room  with  them  at  each  visit,  when  often  all  that  is 
said  will  be:  "  Anything  new  today?  "  "  Xo,  nothing,  Doctor." 
"  All  right."  This  gives  the  opportunity  for  any  necessary  report 
and  instructions  without  making  anything  unusual  of  it. 

Cheerfulness  in  the  sick  room.  A  cheerful  manner  and  face 
—  not  determinedly  hilarious,  but  serene  and  unworried  —  will 
be  of  great  help  to  the  patient's  courage  in  fighting  against  the 
illness.  The  nurse  should  also  take  care  that  those  who  are  allowed 
to  visit  the  patient  do  not  stay  too  long  or  become  tiresome.  Care 
must  often  be  taken  that  those  who  visit  the  sick  room  do  not  tell 
stories  of  similar  illnesses.  The  things  which  are  done  in  this  way 
seem  almost  incredible.  In  one  household  where  my  patient  was 
suffering  from  a  mild  case  of  typhoid,  I  was  relieved  by  a  nurse  of 
experience.  Every  afternoon  after  my  period  of  rest  I  found  the 
patient  worse,  either  terribly  excited  or  so  depressed,  mentally 
and  physically,  that  it  was  some  time  before  I  could  restore  her 
to  the  condition  in  which  I  left  her.  I  was  certain  that  something 
which  took  place  in  my  absence  caused  the  change,  but  neither 
the  physician  nor  I  could  find  out  what  it  was.  At  last  I  sug- 
gested that  I  should  take  the  entire  charge  of  the  case,  getting 
what  sleep  I  could  while  my  patient  slept.  This  change  having 
been  made,  there  was  a  steady  improvement,  with  no  further 
trouble  during  the  afternoon.  When  the  patient  was  convalescent 
she  told  me  that  the  "  nurse  "  relieving  me  had  told  her  many 
tales  of  people  who  had  become  permanently  insane  from  the 
effects  of  typhoid  fever,  and  described  to  her  graphically  the 


98  Personal  Hygiene  and  Home  Nursing 

deathbed  scenes  which  she  had  witnessed  in  her  experience  with 
this  disease ! 

Another  case  in  my  experience  was  that  of  a  young  mother 
who,  after  losing  her  baby  at  birth  and  practically  reaching  con- 
valescence, began  suddenly  to  run  such  a  high  temperature  that 
typhoid  fever  was  feared.  I  was  put  in  charge  of  the  case,  with 
orders  to  admit  no  one  else  into  the  sick  room.  After  a  few  days 
of  quiet  and  care  the  temperature  went  down.  During  this  time 
she  was  constantly  asking  whether  it  was  her  fault  that  her  baby 
did  not  live,  whether  it  was  true  that  she  would  never  have  a  baby 
that  would  live,  and  other  similar  questions.  At  last  she  explained 
that  two  or  three  of  her  visitors  had  told  her  such  dreadful  things 
that  she  could  not  get  them  out  of  her  head,  and  in  her  bodily  weak- 
ness this  rise  of  temperature  had  been  the  result. 

In  another  case,  where  there  was  persistent,  unexplained  pain, 
and  a  secret  fear  of  cancer,  the  patient  had  heard  from  one  person 
admitted  to  her  room  tales  of  many  cancer  cases  occurring  after 
just  such  pain  as  hers  and  just  such  difficulty  as  the  doctor  was 
having  in  the  study  of  the  case.  Many  otherwise  intelligent 
persons  seem  to  take  delight  in  telling  such  tales,  especially  when 
they  can  pour  them  into  the  ears  of  patients  suffering  from  ail- 
ments similar  to  those  of  which  they  have  heard.  Any  doctor 
will  support  the  nurse  in  turning  such  visitors  out  of  the  room. 


CHAPTER    FOURTEEN 


TEMPERATURE,  PULSE,  AND  RESPIRATION 

DURING  illness  the  production  and  control  of  the  body  heat,  the 
beating  of  the  heart,  and  the  respiration  are  usually  disturbed, 
and  often  in  a  case  of  sickness 
much  information  as  to  the 
nature  or  progress  of  the  disease 
can  be  gained  by  watching  its 
effects  on  these  fundamental 
processes  of  the  body.  It  is 
necessary,  therefore,  in  almost 
all  cases  of  illness,  to  take  the 
temperature  and  count  the  pulse 
and  respiration,  and  the  amateur 
nurse  must  understand  just  how 
this  is  done. 

Taking  the  temperature.  For 
taking  the  temperature,  we  use 
what  we  call  the  clinical  ther- 
mometer. This  thermometer  is 
made  slender  and  small,  so  that 
the  temperature  can  be  taken 
under  the  tongue  and  in  other 
parts  of  the  body.  Before  using 
the  thermometer,  we  must  make 
sure  that  the  mercury  in  it  is 
properly  settled;  for  when  the 
mercury  is  once  up  in  a  clinical  thermometer,  it  will  not  come  down 
of  itself  as  it  does  in  an  ordinary  thermometer.  The  best  way  to 
shake  the  mercury  down  is  to  take  hold  of  the  upper  end  of  the 
thermometer  and  give  it  a  quick,  jerking  swing.  The  tempera- 
ture is  registered  in  from  one  to  five  minutes,  depending  upon  the 
place  in  which  it  is  taken. 

The  usual  places  for  taking  the  temperature  are  (i)  under  the 

99 


FIG.  43.     Shaking  down  a  clinical 
thermometer. 


ioo          Personal  Hygiene  and  Home  Nursing 

tongue,  the  tongue  being  held  well  down  and  the  lips  closed ;  (2) 
under  the  arm,  in  the  groin,  or  in  some  fold  of  the  body ;  or  (3),  in 
the  case  of  infants  or  delirious  patients,  in  the  rectum.  In  taking 
the  temperature  in  the  mouth,  which  is  the  most  usual  way,  we 
must  be  careful  to  see  that  the  mouth  is  not  too  dry  and  that  the 
patient  has  not  just  taken  either  hot  or  cold  fluids.  If  the  mouth 
is  dry  or  hot,  it  is  well  to  rinse  it  out  and  wait  for  ten  minutes 
before  inserting  the  thermometer.  In  taking  the  temperature 
under  the  arm,  we  must  be  sure  that  the  armpit  is  dry  and  that 
the  thermometer  lies  between  the  folds  of  the  skin,  not  touching 
the  garment,  and  also  that  the  arm  is  placed  close  against  the 
side  of  the  body.  In  taking  it  in  the  rectum,  the  thermometer 
should  be  oiled ;  and,  of  course,  a  thermometer  kept  especially 
for  the  purpose  should  be  used  in  taking  the  rectal  temperature. 

Differences  in  the  temperature  of  different  parts  of  the  body. 
The  temperatures  of  the  different  parts  of  the  body  are  not  exactly 
the  same.  The  axillary  or  armpit  temperature  is  %°  lower  than 
that  of  the  mouth,  and  as  the  thermometer  records  more  slowly 
under  the  arm  it  should  be  kept  there  from  five  to  ten  minutes. 
The  rectal  temperature  is  |-°  higher  than  the  mouth  temperature. 
In  interpreting  the  record  on  a  temperature  chart,  we  understand 
that  a  mouth  temperature  has  been  taken  unless  the  contrary  is 
indicated.  If  it  has  been  taken  either  in  the  axilla  or  the  rectum, 
that  fact  must  be  noted  on  the  chart.  If  such  an  entry  should  be 
made  and  not  properly  indicated,  the  chart  would  not  be  accurate, 
as  the  temperature  would  be  either  higher  or  lower  than  it  would 
have  been  if  taken  in  the  mouth,  and  the  reader  of  the  chart  would 
have  no  sure  guide  as  to  its  exact  meaning. 

Variations  in  temperature.  The  normal  temperature  is  98.4°  F. ; 
96.5°  to  98°  is  subnormal;  96.5°  indicates  collapse;  subfebrile  is 
99.5°  to  100.5°  5  moderate  fever  is  indicated  by  100.5°  to  100.7°  m 
the  morning  and  102°  to  103°  in  the  evening;  high  fever,  102° 
to  104°  in  the  morning  and  104°  to  105°  in  the  evening ;  105°  to 
110°  means  intense  fever. 


Temperature,  Pulse,  and  Respiration  101 

For  mild  cases  of  fever  it  is  customary  to  take  the  temperature 
twice  daily  at  intervals  of  from  ten  to  twelve  hours.  That  is,  if 
it  has  been  taken  at  8  A.M.  it  should  be  taken  again  at  8  P.M. 
The  temperature  is  lower  in  the  morning  than  in  the  evening. 

Accuracy  in  taking  temperatures.  We  must  be  absolutely  sure 
that  we  take  the  temperature  accurately.  If  it  varies  greatly 
from  the  last  time,  the  thermometer  should  be  shaken  down  and 
the  temperature  taken  again.  Any  sudden  change  in  the  midst  of 
an  illness  is  an  indication  of  trouble  and  should  be  reported  imme- 
diately. 

Fever  above  105°,  if  long  continued,  will  leave  the  patient  in  a 
critical  condition.  Occasionally  the  temperature  may  run  up 
excessively  high,  as  in  a  sunstroke,  and  sometimes  in  fever  or 
nervousness,  and  the  patient  still  live;  but  if  such  temperature 
continues  long,  death  will  be  the  result. 

Excessively  low  temperature  usually  indicates  heart  weakness, 
and  sometimes  this  condition  continues  for  weeks  in  cases  of 
chronic  heart  or  kidney  diseases.  Under  all  other  circumstances  a 
low  temperature  should  be  considered  as  indicating  collapse, 
particularly  when  coming  in  the  midst  of  an  attack  of  typhoid  fever 
or  other  acute  disease. 

End  of  fever.  Fever  ends  in  two  ways,  by  crisis  and  by  lysis. 
Crisis  means  a  sudden  change,  and  lysis  a  slow  change.  For  in- 
stance, in  typhoid  fever  we  say  that  the  temperature  ends  by  lysis. 
This  is  a  gradual  trend  of  the  temperature  downward.  It  con- 
tinues to  range  much  higher  in  the  evening  than  in  the  morning, 
but  at  the  same  time  each  day's  record  of  temperature  is  lower  than 
that  of  the  day  before.  Pneumonia  is  an  example  of  a  fever  that 
usually  ends  by  crisis ;  after  the  seventh  or  ninth  day,  the  tem- 
perature may  drop  from  103°  or  104°  to  97°  or  98°  (page  174). 
Although  this  is  the  normal  way  for  pneumonia  to  end,  the 
patient  must  be  carefully  watched  and,  when  the  temperature 
suddenly  drops,  stimulated  with  heat  or  medicine  to  prevent 
heart  failure. 


io2          Personal  Hygiene  and  Home  Nursing 

The  pulse.  The  pulse  indicates  the  rapidity  of  the  heart  beat, 
and  the  physician  or  nurse  can  learn  a  great  deal  by  feeling  it. 
The  inexperienced  person,  however,  is  able  to  judge  only  of  the 
rapidity  or  the  slowness,  and  the  strength  or  the  weakness,  of  the 
beat.  The  normal  pulse  in  a  man  is  from  60  to  70  beats  a  minute ; 
in  a  woman,  from  65  to  80  beats ;  and  in  a  child,  from  90  to  100 
beats.  But  there  are  many  individuals  whose  pulse  rate  will  fall 
outside  these  limits. 

Methods  of  taking  the  pulse.  The  pulse  is  taken  by  placing 
the  finger  ends  along  the  course  of  an  artery  near  the  surface  of 
the  body  and  counting  the  beats  for  one  minute.  For  a  person 
of  little  experience  it  is  best  to  take  the  pulse  twice  and  to  take  it 
two  minutes,  to  insure  greater  accuracy.  It  is  generally  taken  at 
the  wrist,  from  the  artery  which  comes  near  the  surface  there  on 
the  thumb  side ;  but  it  can  be  taken  wherever  it  is  possible  to  feel 
an  artery  —  for  example,  at  either  side  of  the  throat,  on  the  artery 
in  front  of  the  ear,  on  the  side  of  the  chin,  or  on  the  inner  side  of  the 
ankle.  In  giving  an  anaesthetic,  it  is  customary  for  the  anaesthetizer 
to  keep  his  finger  on  the  artery  in  front  of  the  ear,  that  he  may  detect 
instantly  a  change  in  the  heart  beat. 

In  taking  the  pulse  the  thumb  is  never  used.  There  is  an  artery 
in  it  near  the  surface,  and  the  nurse  may  count  the  pulse  in  this 
instead  of  in  the  wrist  of  the  patient. 

Variations  in  the  pulse  rate.  The  pulse  rate  varies  according  to 
age ;  the  old  have  a  much  slower  pulse  than  the  young.  A  sudden 
movement  will  change  the  rates,  particularly  if  there  is  any  weak- 
ness in  the  body.  So,  in  taking  the  pulse  of  a  sick  person,  if  it  is 
excessively  high,  we  must  always  consider  whether  the  patient 
has  been  quiet  or  whether  there  has  been  any  sudden  movement. 
Excitement  will  increase  the  heart  beat ;  so  will  going  up  steps  or 
going  fast  on  a  level.  It  is  more  rapid  when  one  is  standing  than 
when  one  is  lying. 

There  are  many  other  facts  that  have  to  be  noticed  concerning 
the  pulse  besides  its  rapidity.  Among  these  may  be  mentioned 


Temperature,  Pulse,  and  Respiration  103 

its  rhythm  —  whether  it  is  regular  or  irregular  in  force  and  fre- 
quency ;  whether  it  is  intermittent,  missing  a  beat  now  and  then ; 
or  whether  it  is  large  and  bounding  or  small  and  feeble.  One  must 
observe  also  the  condition  of  the  radial  artery  —  whether  it  is 
compressible  as  it  is  in  the  normal  condition,  or  hard  as  it  is  when 
the  blood  pressure  is  high. 

Respiration  The  normal  respiration  is  from  18  to  24  breaths 
per  minute.  It  is  very  hard  to  get  the  normal  respiration  when  the 
patient  is  conscious  that  it  is  being  taken,  because  the  respiratory 
movements  are  voluntary  as  well  as  involuntary  and  their  rhythm 
can  be  changed  at  will.  A  nervous  or  hysterical  patient  will 
either  decrease  or  increase  her  respiration  if  she  is  conscious  that 
it  is  being  taken.  For  this  reason  the  nurse  has  to  resort  to  many 
tricks  to  make  sure  that  the  normal  breathing  rate  has  been 
recovered.  The  custom  is  to  lay  the  arm  across  the  chest  and,  on 
the  pretense  of  counting  the  pulse,  first  take  the  respiration. 

Sometimes  it  is  necessary  to  finish  taking  the  temperature  and 
pulse  and  count  the  respiration  when  the  patient  is  not  conscious 
of  your  watching  her.  The  facts  to  be  noted  about  respiration  are 
its  rapidity,  its  regularity  or  irregularity,  whether  it  is  labored  or 
easy,  whether  it  is  deep  or  shallow,  and  whether  the  chest  expands 
normally  with  each  breath. 

Relation  of  temperature,  pulse,  and  respiration.  Temperature, 
pulse,  and  respiration  have  a  normal  relation  which  usually  holds  in 
both  health  and  sickness.  That  is,  with  the  increase  of  fever,  there 
is  likely  to  be  increase  in  pulse  and  respiration.  This  is  not  true 
in  all  diseases.  For  example,  in  typhoid  fever,  though  the  tem- 
perature may  be  high,  the  pulse  will  continue  slow  until  the  patient 
is  weakened  by  the  illness.  Then,  though  the  temperature  may 
be  decreasing,  the  pulse  and  respiration  become  more  rapid. 


CHAPTER   FIFTEEN 


FIG.  44.  After  pulling  the  sheet  until  it  is 
tight  over  the  end  of  the  mattress,  lay  it 
smoothly  along  the  side. 


BED   MAKING 

BED  MAKING  as  it  is  done 
in  hospitals  is  a  science,  but 
to  the  inexperienced  it  seems 
far  more  difficult  than  it  is. 
Like  many  other  important 
accomplishments,  it  is  a 
matter  of  knowing  how  to 
do  a  certain  few  things  on 
which  depends  the  success  of 
the  work.  To  make  a  bed 
quickly,  permanently,  and 
comfortably  is  indispensable 
to  good  nursing,  and  any  one 
can  learn  how  it  is  done. 
The  inexperienced  nurse  worries  over  having  to  change  a  bed 
with  her  patient  in-  it,  postpones  it  until  the  last  minute,  and 
later,  after  a  little  instruction  and  practice,  finds  it  so  simple  that 
she  looks  back  with  surprise  at  her  fears. 

Learning  to  make  a  bed.  It  is  well  to  practice  first  with  an 
empty  bed,  learning  to  fold  and  slip  the  sheets  smoothly ;  then, 
for  practice  in  turning  and  lifting  a  patient,  let  a  child,  or  an  adult 
who  is  well,  take  the  place  upon  the  bed. 

The  first  step  in  making  a  bed  is  to  have  ready  everything  that 
is  to  be  used.  Sheets  should  be  aired,  and,  in  winter,  warmed ; 
and  of  course  they  should  be  thoroughly  dried.  Plan  the  work 
before  beginning,  and  have  all  the  various  steps  in  mind  so  that 
there  will  be  no  delay  or  awkwardness  after  the  work  is  begun.  It 
may  be  a  good  plan  to  make  out  a  list  of  all  the  movements  from 
beginning  to  end,  and  use  this  list  until  the  order  of  procedure  is 
thoroughly  learned.  Nothing  tires  a  nervous  patient  more  than 
the  awkwardness  due  to  half-formed  plans  or  the  delays  caused  by 
going  for  forgotten  articles. 

104 


Bed  Making 


FIG.   45. 


Tuck  the  lower  part  well  under 
the  mattress. 


Making  up  an  empty  bed. 
Take  everything  of!  the  bed 
and  turn  the  mattress.  Put 
the  blanket,  rubber  sheet, 
mattress  pad,  or  whatever  is 
used  to  protect  the  mat- 
tress, in  place  and  see  that 
it  lies  perfectly  straight 
and  without  wrinkles.  The 
bottom  sheet  should  then  be 
put  on  tight  and  straight, 
stretched  well  over  the  bed, 
and  tucked  in  at  the  sides 

and  corners.  An  excellent  method  of  arranging  the  corners 
is  that  sometimes  called  the  "  envelope  corner."  It  is 
neat  in  appearance  and  holds  the  sheet  firmly  in  place.  The 
lower  sheet  is  placed  on  the  bed  and  the  corners  secured  in 
the  following  way: 

(1)  Spread  the  sheet  straight  upon  the  bed.     If  not  straight  it 
will  pull  into  wrinkles  and  not  be  firm. 

(2)  Tuck  the  sheet  well  under  the  mattress  at  the  top. 

(3)  Then,  catching  hold  of  it  at  the  side,  pull  the  folded  under 
part  of   the  sheet  firmly   toward   you  until  it  is  smooth   and 
straight  under  the  mattress. 

(4)  Take  hold  of  that  part  of  the  sheet  which  is  a  continuation 
of  the  part  covering  the  end  of  the  mattress,  and  after  pulling  the 
sheet  until  it  is  tight  over  the  end  of  the  mattress,  lay  it  smoothly 
along  the  side.     The  part  of  the  sheet  lying  against  the  side  of 
the  mattress  should  be  a  direct  continuation  of  the  part  covering 
the  end  of  the  mattress. 

(5)  Tuck  the  part  of  the  sheet  which  falls  below  this  well  under 
the  mattress. 

(6)  Still  holding  the  sheet  firmly  against  the  side  of  the  mattress, 
bring  the  part  above  over  and  tuck  it  under  the  mattress.     If 


106          Personal  Hygiene  and  Home  Nursing 


FIG.  46.  Still  holding  the  sheet  firmly  against 
the  side  of  the  mattress,  bring  the  part}  above 
over  and  tuck  it  under  the  mattress. 


correctly  and  smoothly  done, 
the  sheet  should  form  a  di- 
agonal fold  at  the  corner  of 
the  mattress. 

(7)  After  folding  and  tuck- 
ing in  the  two  ends  of  the 
sheet  in  this  way,  push  the 
sides  of  the  sheets  under  as 
far  as  they  will  go.  The 
farther  under  the  mattress 
the  sheet  is,  the  less  likely  it 
is  to  wrinkle. 

The  top  sheet  is  put  on  in 
a  similar  way,  but  with  the 
wrong  side  up,  so  that  the 
hem  when  turned  over  will 

be  right  side  out ;  the  broad  hem  in  both  sheets  is  of  course  at 
the  top.  The  top  sheet  is  pulled  down  well  at  the  foot,  and  not 
tucked  in  at  the  side  as  far  as  the  upper  sheet,  so  that  opening 
the  bed  will  not  loosen  the  lower  sheet. 

Rubber  sheets  and  draw  sheets.  Rubber  and  draw  sheets  are 
used  for  a  bed  patient.  For  ordinary  cases  a  small  rubber  sheet 
is  sufficient.  This  goes  over  the  linen  sheet,  and  must  extend 
from  at  least  the  waist  line  of  the  patient  down  almost  to  her  feet 
and  be  wide  enough  to  tuck  well  under  the  mattress  at  the  sides. 
It  is  not  a  good  plan  to  pin  the  rubber  sheet  to  the  mattress  with 
safety  pins,  as  the  weight  and  movements  of  the  patient  are  apt 
to  tear  it  at  the  places  where  it  is  pinned. 

For  a  case  of  typhoid  fever,  or  where  there  is  inability  to  retain 
urine  or  feces,  it  is  better  to  have  a  rubber  sheet  over  the  whole 
mattress,  as  well  as  the  narrow  one  over  the  bottom  sheet.  Large 
rubber  sheets  are  made,  with  reinforced  holes  at  the  sides  and  ends 
into  which  tapes  can  be  run  and  the  sheet  fastened  to  the  frame  of 
the  bed. 


Bed  Making 


107 


FIG.  47.     If  the  work  is  correctly  and  smoothly  done,  the  sheet 
should  form  a  diagonal  fold  at  the  corner  of  the  mattress. 

The  draw  sheet  is  drawn  crosswise  on  the  bed  over  the  small 
rubber  sheet.  It  should  be  wide  enough  completely  to  cover  the 
small  rubber  one,  and  is  useful  (i)  to  cover  the  rubber  sheet; 
(2)  to  protect  the  bottom  sheet  in  the  part  where  it  is  most  likely 
to  be  soiled ;  (3)  because  it  is  easy  to  change ;  (4)  because  it  is 
easier  to  wash  than  the  large  sheet ;  (5)  because  it  can  be  easily 
and  quickly  tightened  and  smoothed  under  the  patient. 

Changing  the  sheets  with  the  patient  in  the  bed.  There  are 
several  methods  of  changing  the  sheets  on  the  bed  while  the  patient 
is  lying  in  it.  The  method  to  be  used  in  any  given  case  depends 
upon  the  condition  of  the  patient  and  the  preference  of  the  nurse. 
The  following  is  a  satisfactory  way,  when  the  patient  can  be  turned : 

(1)  Put  her  on  her  side,  with  her  back  toward  you. 

(2)  Remove  the  heavy  top  covers,  leaving  in  winter  just  enough 
light  blankets  or  comfortables  to  keep  your  patient  from  being 
chilled. 

(3)  Loosen  the  bottom  sheet  at  the  side  from  which  you  work, 
at  both  the  foot  and  the  head  of  the  bed.     Then  either  lay  it  in 
folds  or  gather  it  loosely  together,  and  push  it  up  close  to  the 
patient. 


io8          Personal  Hygiene  and  Home  Nursing 


(4)  On  a  couch   or   table 
(not    on    the    bed    of    your 
patient)  lay  the  fresh  sheet 
in  long,  smooth  folds,  leav- 
ing one  side  unfolded  to  be 
tucked  under  the  edge  of  the 
mattress. 

(5)  Lay  the  fresh  sheet  on 
the  mattress  and  tuck  in  the 

^7  unfolded     side     the     whole 

length  of  the  bed. 

(6)  Push  the  folds  of  the 
sheet   close   to  the  back  of 
the    patient    and    turn    the 
patient   over  with   her  face 
to  the  side  of  the  bed  covered 
by  the  clean  sheet.     Then  go 
to  the  other  side  of  the  bed, 
where    the    soiled    and    the 
clean  sheet  will  both  be  at 
the  back  of  the  patient. 

The  soiled  sheet  can  then 
be  easily  removed  and  the 

clean  one  drawn  over,  tucked  in,  and  the  corners  secured.  The 
draw  and  rubber  sheets  can  be  changed  by  the  same  method  at  the 
same  time  as  the  large  sheet  if  necessary,  by  rolling  them  up  with 
the  soiled  sheets  and  laying  the  clean  draw  and  rubber  sheets  on 
top  of  the  clean  bottom  sheet. 

With  a  helpless  patient  it  is  easier  to  change  either  from  the 
head  or  the  foot  of  the  bed.  I  have  found  working  from  the  foot 
of  the  bed  the  best  plan,  as  it  is  easier  to  reach  it  than  the  head 
of  the  bed,  which  is  often  against  the  wall.  The  patient  is  also 
much  less  disturbed  in  the  first  part  of  the  preparation,  when  one 
works  about  the  feet.  In  this  case  the  steps  are  as  follows : 


FIG.  48.  Push  both  the  soiled  sheet  and  the 
folds  of  the  clean  sheet  close  to  the  back  of 
the  patient  and  turn  her  over  to  the  side  of 
the  bed  covered  with  the  clean  sheet. 


Bed  Making 


109 


FIG.  4g.    The  "soiled  sheet  and  the  clean  sheet  will  be  found  at  the 
back  of  the  patient. 

(1)  Loosen  the  bottom  sheet  as  before  and  push  it  up  from  the 
bottom. 

(2)  Fold  the  clean  sheet  crosswise  instead  of  lengthwise  as 
before,  and  tuck  it  in  at  the  foot  of  the  bed.     Be  sure  to  leave 
enough  length  to  reach  well  to  the  head  of  the  bed. 

(3)  Lift  the  feet  and  push  up  both  sheets ;  then  lift  the  legs  and 
work  the  sheets  farther  upward.     If  the  patient  is  strong  enough, 
bend  her  knees  and  let  her  help  raise  her  buttocks. 

(4)  After  this  put  your  arm  around  her  and  raise  her  shoulders 
and  head,  pull  the  pillows  out,  and  bring  up  the  two  sheets. 


no          Personal  Hygiene  and  Home  Nursing 

Remove  the  soiled  one,  replace  the  pillow,  and  lay  your  patient 
down. 

(5)  Tuck  the  top  of  the  sheet  under  the  mattress  and  fix  the 
corners. 

When  changing  from  the  head,  this  order  is  reversed.  If  a 
patient  is  unconscious  and  absolutely  helpless,  a  second  person 
should  help ;  then,  with  one  person  on  each  side  of  the  bed,  the 
sheets  can  be  drawn  along  and  the  patient  lifted  with  little  trouble 
to  the  nurse  and  much  less  fatigue  to  the  patient. 

To  change  the  upper  sheet,  lay  it  over  the  top  of  the  soiled  sheet, 
and  in  winter  over  the  top  also  of  a  small  blanket,  taking  care  not 
to  fan  the  air  over  the  patient  with  the  sheet.  If  the  patient  is 
not  too  weak  to  help,  let  her  hold  the  top  of  the  clean  sheet  as  you 
slip  the  other  from  under  it.  If  the  patient  is  too  weak  to  assist, 
tuck  the  corners  of  the  clean  sheet  under  her  shoulders,  then  care- 
fully remove  the  soiled  one. 

Lifting  and  moving  a  patient  in  bed.  When  lifting  a  patient  to 
turn  her  pillow  or  to  adjust  the  sheet  or  gown,  stand  on  the  right 


FIG.  50.     Changing  the  sheet  from  the  bottom  of  the  bed. 


Bed  Making 


in 


FIG.  51.    Lifting  a  patient  in  the  bed. 

side  of  the  bed  and  let  her  put  her  arms  around  your  neck.  Then 
put  your  left  arm  around  and  under  her  shoulder,  leaving  your 
right  arm  free  for  the  work.  To  move  her  to  the  side  of  the  bed, 
slip  your  arms  under  her  shoulder  and  hips  and  draw  her  toward 
you. 

Changing  the  nightgown.  If  the  patient  is  to  be  kept  in  bed  for 
a  long  time,  it  is  much  better  to  split  the  nightgown  in  the  back. 
It  is  then  easier  to  change,  and  as  the  patient  does  not  lie  on  it, 
it  is  less  quickly  soiled.  Also  it  makes  one  thing  less  to  keep  smooth 
under  the  back.  If  split  to  the  neckband  or  yoke,  it  is  easily  put 
on,  and  is  still  held  in  place.  When  removing  a  nightgown,  if  it 
has  not  been  split,  draw  the  skirt  of  the  gown  well  up  from  under 
the  buttocks,  draw  one  sleeve  off,  and  lift  the  gown  over  the 
patient's  head ;  then  slip  off  the  second  sleeve.  In  putting  on  the 
fresh  gown,  the  order  is  reversed :  put  one  sleeve  on,  put  the  gown 
over  the  patient's  head,  put  the  second  sleeve  on,  then  pull  the 
gown  down  under  the  patient.  If  the  patient  is  weak,  put  your 
hand  through  the  bottom  of  the  sleeve  and,  catching  hold  of  her 
hand,  pull  it  through  the  sleeve. 


ii2          Personal  Hygiene  and  Home  Nursing 

Changing  the  mattress.  A  nurse  should  never  attempt  to 
change  a  mattress  on  which  a  patient  is  lying,  without  adequate 
help.  The  mattresses  must  be  carefully  held  lest  the  patient 
have  a  fall;  and  this  requires  the  aid  of  several  persons.  The 
easiest  way  to  move  a  patient  from  one  mattress  to  another  is  to 
lift  her  to  one  side  of  the  mattress  upon  which  she  is  lying,  pull  it 
half  off  the  bed,  put  the  fresh  mattress  on  the  uncovered  half  of 
the  bed  and  close  to  the  first  mattress,  and  then  draw  the  sheet 
on  which  the  patient  is  lying  over  on  the  fresh  mattress. 

To  turn  the  mattress  over,  pull  it  one  half  off  the  bed  in  the  same 
way,  place  pillows  on  the  empty  side  of  the  bed  and  move  the 
patient  over  on  to  them ;  turn  the  mattress  and  move  the  patient 
back.  This  should  not  be  done  to  a  weak  or  nervous  patient,  as 
the  fear  of  falling  is  much  greater  if  pillows  are  used  instead  of 
mattresses. 

Changing  from  one  bed  to  another.  This  should  not  be  under- 
taken without  plenty  of  help.  Each  person  should  understand 
clearly,  before  beginning,  the  precise  duties  assigned  to  her  and 


FIG.  52.    A  chair  used  as  a  bed  rest. 


Bed  Making 

attend  strictly  to  these.    Failing  to  hold  the  beds  steady  or  letting 
go  of  the  patient  might  mean  a  fall  and  possible  injury. 


FIG.  53.    A  bed  support  to  keep  a  patient  from  slipping  down  in  bed. 

If  the  beds  are  of  even  or  almost  even  height,  they  should  be 
placed  together  side  by  side.  The  patient  is  then  moved  to  the 
edge  of  the  mattress  nearest  the  second  bed,  and  the  mattress  on 
which  the  patient  is  lying  is  drawn  partly  off  in  the  direction  away 
from  the  second  bed.  The  mattress  of  the  second  bed  is  then 
brought  over  until  half  of  it  rests  on  the  first  bed.'  The  two  beds 
must  be  held  closely  together  and  the  mattresses  firmly  supported 
while  this  is  being  done.  The  patient  is  then  drawn,  on  a  sheet  or 
strong  bed  pad,  over  on  to  the  second  mattress  and  slid  back  in 
place  on  the  fresh  bed.  If  this  is  done  quietly  and  carefully,  each 
one  attending  to  her  own  task,  there  need  be  no  strain  or  nervous 
excitement  on  the  part  of  the  patient. 

If  the  beds  are  of  unequal  height  and  the  patient  must  be  lifted, 
place  the  beds  side  by  side  but  with  the  head  of  one  bed  near  the 
foot  of  the  other,  leaving  a  triangular  space  between  the  beds 
large  enough  to  permit  the  nurses  to  turn  around.  Then  the 
nurse,  with  two  or  three  assistants,  must  go  in  between  the  beds, 
slip  their  hands  and  arms  under  the  head  and  shoulders  and  back 


U4          Personal  Hygiene  and  Home  Nursing 

and  legs  of  the  patient,  lift  her,  and  then  turn  around  and  lay  her 
in  the  fresh  bed. 

Arranging  pillows.  Every  person  has  some  individual  way  of 
arranging  pillows,  and  a  nurse  should  learn  to  stick  them  up,  flat- 
ten them  down,  or  place  them  in  whatever  way  the  patient  prefers 
them.  Much  can  be  done  with  small  pillows  to  make  the  patient 
comfortable.  Placing  one  under  the  abdomen  when  lying  on  the 
side  will  often  relieve  abdominal  pain.  Pillows  under  the  knees, 
of  different  heights,  will  relieve  the  strain  when  lying  on  the 
back.  A  pillow  under  the  feet,  or  between  the  feet  and  the  foot  of 
the  bed,  will  keep  the  patient  from  slipping  down  in  bed  and  will 
prove  restful  to  her.  Pillows  may  be  put  under  elbows,  under  the  hol- 
low in  the  back,  and  in  fact  almost  anywhere  that  support  is  needed. 
Sometimes,  when  a  patient  cannot  turn,  the  nurse's  hand  can  be  run 
under  one  shoulder  or  side,  the  patient  lifted  slightly  and  a  little 
pillow  tucked  under  the  side.  A  good  nurse  is  one  who  not  only 
knows  how  to  give  medicines  and  wait  on  the  doctor,  but  who  also 
remembers  the  little  things  that  can  be  done  to  relieve  the  strain 
and  nervousness  of  the  patient. 

Bed  rests.  Bed  rests  can  be  bought  to  support  a  patient  who 
is  sitting  up  in  bed,  but  as  a  substitute  a  small,  straight  chair  may 
be  used.  The  chair  is  turned  upside  down  on  the  bed,  the  back 
of  the  chair  forming  an  incline  to  hold  the  pillows.  One  often  slips 
down  in  bed,  and  this  can  be  prevented  by  placing  a  pillow  under 


V.        \   \ 

FIG.  54.    Another  type  of  bed  support  that  can  easily  be  made  at  home. 


Bed  Making  115 

the  knees.  To  keep  this  pillow  from  slipping,  double  it  over  a 
small  rope  or  twisted  sheet  and  tie  the  ends  of  the  rope  or  sheet  to 
the  sides  or  top  of  the  bed  frame.  Small  bed  supports  resem- 
bling little  seats  can  be  made  in  two  ways:  (i)  Two  boards 
with  edges  beveled  on  one  side  are  fastened  together  with  hinges. 
Two  iron  supports  swinging  from  the  top  and  fitting  into  holes  in 
each  side  of  the  lower  board  make  it  possible  to  adjust  the  seat 
(Fig.  53).  (2)  A  frame  to  support  the  patient  may  be  made  as 
is  shown  in  Figure  54.  Either  of  these  supports  should  be  cov- 
ered with  a  pillow  when  in  use  and  must  be  tied  with  cords  to  the 
frame  at  the  side,  or,  with  a  heavy  patient,  to  the  head  of  the  bed. 


CHAPTER   SIXTEEN 

BATHING  A  PATIENT  IN  BED 

THE  morning  bath  should  be  given  each  day  about  an  hour 
after  breakfast.  While  the  patient  rests  after  eating,  the  nurse 
should  be  preparing  everything  needed  for  the  bath.  In  this,  as 
in  other  matters  connected  with'  the  care  of  the  sick,  no  good 
nurse  will  ever  be  obliged  to  stop  what  she  is  doing  in  order  to  get 
something  forgotten  in  the  preparations.  It  is  well  for  the  in- 
experienced nurse  to  make  out  a  list  of  what  will  be  needed,  and 
to  refer  to  this  until  she  is  so  accustomed  to  the  work  that  the  list 
is  no  longer  required.  In  making  out  the  list,  put  down  the  things 
to  be  done  in  the  order  in  which  they  will  be  done ;  time  yourself 
and  see  how  quickly  the  preparations  can  be  made. 

Preparations  for  the  bath.  The  following  preparations  should 
be  made  before  the  giving  of  the  bath  is  begun : 

(1)  See  to  it  that  the  temperature  of  the  room  is  between  72° 
and  75°  F. 

(2)  Put  sheets  to  air,  and,  in  winter,  to  warm. 

(3)  Put  nightgown  .to  warm. 

(4)  Have  ready  the  following  articles : 

Two  single  blankets,  warmed 

1  face  towel 

2  or  3  bath  towels 
2  wash  cloths 
Soap 

Grain  alcohol 

Tub  or  large  bowl 

Slop  jar  or  pail 

Low  table,  stool,  or  chair  for  bowl 

Hot  and  cold  water 

Administering  the  bath.  When  everything  is  ready,  put  one 
blanket  under  the  patient  in  the  same  way  in 'which  the  lower 
sheet  is  changed.  Put  the  second  blanket  over  the  patient  and 
remove  the  nightgown.  Begin  by  bathing  the  face  and  ears.  Go 

116 


Bathing  a  Patient  in  Bed  117 

over  the  body  in  this  order :  face,  ears,  neck,  arms,  chest  and 
abdomen,  feet  and  legs;  then  turn  the  patient  on  her  side  and 
wash  her  back,  and  while  she  is  in  this  position  rub  the  back  and 
shoulders  with  alcohol.  Then  turn  the  patient  on  her  back  again 
and  wash  the  pubic  region. 

Be  careful  not  to  uncover  at  one  time  more  of  the  body  than  is 
absolutely  necessary.  Wash,  dry  thoroughly,  and  cover  each 
part  before  going  on  to  the  next.  Don't  be  afraid  to  wet  your 
patient,  but  at  the  same  time  be  careful  not  to  have  the  cloth  so 
wet  that  it  will  drip  over  the  blanket  and  towels.  Use  bath 
.towels  to  keep  the  blankets  dry,  laying  them  between  the  part  to 
be  washed  and  the  blankets.  In  cold  weather,  or  if  the  patient 
is  very  sensitive  to  the  air,  the  whole  bath  may  be  given  under  the 
blankets,  protecting  them  above  and  below  with  the  towels.  The 
water  in  the  bowl  should  be  changed  at  least  twice,  —  once  after 
bathing  the  trunk,  and  again  after  bathing  the  feet  and  legs.  If 
the  patient  is  not  too  weak,  put  the  hands  and  feet  into  the  bowl, 
as  this  is  very  refreshing.  For  the  feet,  the  bowl  is  set  on  the  bed 
and  steadied  carefully,  and  the  feet  lifted  and  put  into  the  bowl, 
one  foot  at  a  time.  If  the  patient  is  able  to  help  herself,  use  a  foot 
tub  and  put  in  both  feet.  When  using  the  tub  on  the  bed,  it  is 
best  to  protect  the  bed  with  a  rubber  sheet  covered  with  a  bath 
towel. 

Dry  the  patient  carefully,  grasping  the  towel  firmly,  so  that  it 
will  not  merely  slip  over  the  skin.  Wipe  thoroughly  between 
the  fingers  and  toes  and  in  the  folds  of  the  body.  If  your  patient 
seems  tired  after  her  bath,  leave  her  between  the  blankets  while 
you  set  the  room  in  order ;  then  remove  the  blankets  and  put  on 
the  nightgown. 

It  is  well  to  have  a  regular  order  for  the  morning's  work.  At 
the  same  time,  never  lose  sight  of  the  fact  that  what  you  are  doing 
is  for  the  health  and  comfort  of  the  patient.  If  she  is  tired  or 
nervous,  it  is  better  to  leave  the  combing  of  the  hair  or  the  clean- 
ing of  the  teeth  until  later  in  the  day.  Do  not  insist  on  a  fixed 


n8          Personal  Hygiene  and  Home  Nursing 

routine  regardless  of  her  feelings  or  strength.  If  she  is  not  really 
weakened,  but  merely  peevish,  a  little  tactful  yielding  on  your 
part  in  things  not  essential  often  helps  to  carry  your  point  in  things 
which  are  essential. 

Except  when  the  patient  is  extremely  ill,  the  hair  should  be 
combed  daily.  It  should  be  divided  into  two  parts  and  plaited  at 
the  sides  of  the  head,  high  enough  not  to  get  under  the  ears  when 
the  patient  is  lying  on  her  side.  If  the  hair  is  thick  and  long  and 
the  patient  tires  easily,  comb  one  half  in  the  morning  and  the 
other  half  later.  The  mouth  should  be  washed  out  and  the  teeth 
cleansed  at  least  twice  a  day.  If  the  patient  is  strong  enough, 
even  if  not  able  to  sit  up,  she  should  be  able  to  clean  her  teeth 
quite  comfortably  by  the  use  of  a  small  toothbrush  and  a  little 
kidney-shaped  basin  to  hold  under  her  chin.  If  she  is  not  strong 
enough  for  this  even  with  some  assistance,  the  mouth  must  be 
washed  out  by  the  nurse.  An  orangewood  stick  wrapped  in  gauze 
or  absorbent  cotton  can  be  used,  but  the  cleaning  is  more  thorough 
when  done  with  the  finger.  Wash  thoroughly  the  inside  of  the 
teeth  and  up  well  on  the  gums,  and  clean  the  tongue  well,  par- 
ticularly if  there  is  fever.  A  pleasant  mouth  wash  is  made  of 
one-half  glass  of  water,  a  teaspoonful  of  listerin,  and  a  teaspoonful 
of  glycerin.  This  wash  keeps  the  tongue  moist  and  is  pleasant 
to  the  taste.  If  the  tongue  is  much  coated,  use  peroxid  of  hydro- 
gen ;  it  is  cleansing  and  can  be  used  undiluted. 

Baths  for  therapeutic  purposes.  Many  baths,  such  as  cold  and 
hot  packs,  cold  sponge  baths,  alcohol  baths,  cold  or  tepid  "  bed 
tub  "  baths,  cold  sprays,  and  steam  baths,  are  given  in  bed  for 
therapeutic  purposes.  Cold  packs  are  given  either  to  quiet  the 
nerves  or  to  reduce  fevers.  For  the  pack  usually  given  to  quiet 
and  induce  sleep,  the  articles  needed  are : 

2  blankets 

2  sheets 

A  foot  tub  full  of  water  70°  to  80°  F.  in  temperature 

A  rubber  sheet 


Bathing  a  Patient  in  Bed  119 

Ice  bag  or  gauze  for  compresses 

Ice 

A  hot-water  bag  for  the  feet 

Put  the  rubber  sheet  and  one  blanket  under  the  patient.  Wet 
the  sheets  thoroughly  in  the  tub,  then  wring  them  dry  enough  not 
to  drip,  and  put  one  sheet  under  and  one  over  the  patient,  tuck- 
ing them  in  about  the  legs  and  the  arms  and  body.  Fold  the  sides 
of  the  first  blanket  over  the  sheets  and  pin  them  together.  Then 
cover  all  with  the  second  blanket,  tucking  it  well  under  the  sides 
of  the  patient  and  around  the  feet.  Put  the  ice  bag  to  her  head 
and  the  hot-water  bag  to  her  feet.  If  she  shivers  when  first  put 
into  the  sheets,  the  reaction  will  be  better.  She  can  be  left  in  the 
pack  for  one  or  two  hours  and  may  fall  asleep.  When  a  pack  is 
to  be  given  to  reduce  fever,  use  only  one  blanket  and  keep  the 
sheets  wet  by  sprinkling  them  occasionally  for  fifteen  minutes 
with  the  hand  or  a  whisk  broom. 

Giving  a  tub  bath  in  bed.  A  spray  or  tub  bath  can  be  given  in 
bed  with  little  fatigue  to  the  patient.  For  this  bath  it  is  best  to 
have  two  large  rubber  sheets.  One  is  placed  on  the  bed  under  the 
bottom  sheet;  the  other  over  the  bottom  sheet,  but  under  the 
patient.  Stretch  strong  cords  from  the  head  to  the  foot  of  the 
bed  on  both  sides  at  a  height  of  a  foot  or  a  foot  and  a  half  above 
the  mattress.  Then  bring  the  edges  of  the  rubber  sheet  up  over 
the  cord  on  each  side,  fastening  it  securely  with  clothespins.  At 
the  head  and  foot  of  the  bed,  bring  up  the  ends  of  the  sheet  and 
fasten  them  to  the  bed,  or  to  the  cords  at  the  corners  of  the  bed. 

After  the  bath,  the  water  may  be  dipped  out  and  the  rubber 
sheet  dried  with  towels.  Two  nurses  working  together  can  care- 
fully unfasten  the  bottom  end  of  the  rubber  sheet  from  the  cord,  roll 
it  into  a  funnel  shape,  and  let  the  water  run  out  into  a  tub  or  pail 
placed  at  the  foot  of  the  bed.  After  the  patient  has  been  dried, 
the  rubber  sheet  should  be  removed  from  the  bed. 

Giving  a  sponge  bath  to  reduce  fever.  Cold  sponge  baths  are 
given  to  reduce  fever.  Place  yjour  patient  between  blankets. 


120          Personal  Hygiene  and  Home  Nursing 

Then  with  a  soft  sponge  or  wash  cloth  proceed  as  in  a  bath  for 
cleansing  purposes;  only  do  not  wipe  the  patient,  but  leave  the 
parts  of  the  body  more  uncovered  and  allow  the  water  to  dry  by 
evaporation.  The  water  used  may  be  of  the  temperature  of  water 
as  it  ordinarily  runs  from  the  cold  faucet,  or  if  the  patient's  tem- 
perature is  very  high,  ice  may  be  added  to  make  the  water  cold. 
If  the  patient  is  very  nervous  and  objects  seriously  to  the  cold,  do 
not  insist  on  the  use  of  ice  in  .the  water,  for  the  nervousness  and 
irritation  of  the  patient  will  largely  counteract  the  results  which 
might  be  obtained  from  the  iced  water.  The  bath  should  continue 
for  from  fifteen  minutes  to  half  an  hour.  The  strokes  with  the 
wash  cloth  should  not  be  too  heavy.  They  are  generally  up,  but 
their  direction  makes  little  difference.  Keep  cold  cloths  or  an 
ice  bag  on  the  head  and,  if  necessary,  a  hot-water  bottle  at  the 
feet.  Your  patient  must  never  be  allowed  to  have  cold  feet. 
The  temperature  of  the  patient  is  taken  about  half  an  hour  after 
the  bath,  and  will  indicate  the  effect  of  the  bath. 

Salt  rubs.  Salt  rubs  are  very  easy  to  give  and  are  valuable 
for  their  stimulating  and  strengthening  effects.  They  can  be  given 
in  two  ways : 

(1)  Rub  the  body  briskly  with  a  handful  of  wet  salt;  then 
either  spray  off  with  cold  water  or  take  a  quick  cold  tub  bath. 

(2)  Dip  a  towel  in  a  strong  solution  of  salt  and  let  it  dry ;  then 
rub  it  briskly  over  the  body. 

The  first  method  is  the  better,  when  the  nurse  is  helping,  as  she 
can  rub  the  back  and  parts  of  the  body  not  easily  touched  by  the 
patient.  The  second  method  is  best  when  taking  the  bath  alone. 
The  two  methods  can  be  combined,  using  the  salt  towel  for  the 
back. 


CHAPTER   SEVENTEEN 

METHODS  OF  GIVING  VARIOUS  TREATMENTS 

THE  most  perplexing  part  of  home  nursing,  to  the  untrained  and 
inexperienced  nurse,  is  the  giving  of  various  treatments.  As  she 
lacks  the  deft  and  ready  touch  which  training  and  experience  give 
the  professional  nurse,  the  simplest  of  these  appears  to  her  a 
complicated  process.  In  addition  to  this,  the  physician  not  in- 
frequently takes  for  granted  knowledge  which  she  does  not  possess, 
and  she  goes  about  the  task  of  giving  an  enema,  applying  a  com- 
press or  poultice,  or  some  other  common  requirement  of  nursing, 
without  being  at  all  sure  that  she  is  doing  it  as  it  ought  to  be  done. 
Most  of  these  things  are  really  very  simple  when  a  few  special 
points  are  explained;  and  it  is  my  object  in  this  chapter  to  give 
such  explanations  as  the  average  inexperienced  nurse  may  need. 

The  enema  and  its  purposes.  Enemas  are  given  for  three 
purposes:  as  purgatives,  for  nutrition,  and  for  administering 
medicine.  The  simple  enema  for  purgative  purposes  is  the  most 
common;  but  it  is  often  misused,  as  few  people  know  how  to 
administer  it  correctly.  There  seems  to  be  a  general  idea  that  the 
higher  the  bag  is  hung,  the  more  effectual  the  enema  will  be,  and 
that  a  large  quantity  of  water  should  be  used.  It  is  never  necessary 
to  give  more  than  from  one  to  two  quarts  of  water  unless  by  the 
orders  of  the  physician.  A  large  enema  is  not  only  unnecessary, 
but,  given  too  frequently,  it  is  injurious,  as  it  distends  the  walls  of 
the  intestine  more  than  is  necessary,  and  if  repeated  continuously 
will  weaken  them  and  cause  them  to  dilate. 

The  simple  enema.  A  purgative  or  simple  enema  may  be  of 
water,  soapsuds,  or  normal  salt  solution  (a  teaspoonful  of  salt  to  a 
pint  of  water) .  In  the  soapsuds  enema  only  very  pure  soap  should 
be  used ;  castile  soap  is  best.  This  enema  causes  a  certain  amount 
of  irritation  in  the  intestine,  resulting  in  a  movement  of  the  bowels. 
The  enema  should  be  at  a  temperature  of  105°  F.,  as  it  must  be 
either  hotter  or  colder  than  the  body  to  insure  that  it  will  be 
promptly  expelled. 


122  Personal  Hygiene  and  Home  Nursing 

For  giving  an  enema,  a  fountain  syringe  is  the  best.  Unless  a 
high  enema  is  ordered,  the  rectal  nozzle  which  comes  with  the 
bag  is  used ;  for  a  high  enema  a  rectal  tube  which  can  be  bought 
in  any  drug  store  is  slipped  on  over  the  nozzle.  The  rectal  tube 
is  made  of  red  rubber  and  can  be  bought  in  various  sizes  suitable 
to  a  child  or  an  adult. 

Giving  the  enema.  Have  ready  a  bed  pan  and  toilet  paper,  and 
have  the  bed  protected  by  a  rubber  sheet.  Place  the  patient  on 
the  left  side,  with  knees  flexed  and  the  right  knee  drawn  higher 
than  the  left,  as  in  this  position  the  lower  intestine  is  relaxed  and 
the  tube  can  be  more  easily  inserted.  Enemas  are  occasionally 
given  with  the  patient  lying  on  the  back,  with  knees  flexed,  or  in 
the  knee  chest  position,  in  which  the  patient  kneels,  with  chest 
against  the  bed  and  head  turned  sideways.  The  bag  should  be 
hung  only  from  six  inches  to  one  foot  above  the  patient,  as  hanging 
it  higher  causes  pain  in  some  cases,  and  also  makes  it  difficult  for 
the  patient  to  retain  the  water.  Oil  the  tube  before  inserting  it, 
and  let  the  water  run  through  it  until  it  is  warm.  If  the  rectal 
tube  is  used,  it  should  be  carefully  and  gently  introduced  from 
nine  to  twelve  inches.  This  should  give  no  pain  to  the  patient. 

Sometimes  the  tube  will  not  go  into  the  rectum,  owing  to  an 
accumulation  of  feces  in  the  lower  bowel,  a  twist  in  the  tube,  or  a 
failure  to  pass  the  tube  around  a  fold  in  the  intestine.  In  such  a 
case,  open  the  stopcock  and  allow  a  little  water  to  flow  through 
into  the  bowel.  If,  after  this,  it  is  still  difficult  to  insert  the  tube, 
draw  it  well  back  and  introduce  it  again,  slowly  and  gently,  and  it 
will  probably  pass  the  obstruction.  If  the  patient  finds  it  difficult. 
to  retain  the  water  until  the  full  quantity  is  given,  stop  the  flow 
until  the  contraction  of  the  intestine  has  ceased ;  then  continue  the 
flow  of  water. 

An  enema  should  be  retained  from  fifteen  to  twenty  minutes,  and 
then  an  effort  made  to  expel  it.  It  is  not  well  to  allow  the  patient 
to  retain  an  enema  indefinitely.  If  the  feces  are  retained  after 
they  are  softened  by  the  water,  poisonous  matter  may  be  absorbed 


Methods  of  Giving  Various  Treatments         123 

into  the  system.  If  the  first  enema  is  not  expelled  when  it  should 
be,  give  a  small  second  enema,  hanging  the  bag  higher  and  allow- 
ing the  water  to  enter  with  more  force.  If  the  patient  is  not  too 
ill,  getting  up  and  walking  around  will  often  start  the  return  flow. 
If  the  bowels  are  not  evacuated  after  the  second  enema,  massage 
of  the  abdomen,  making  pressure  particularly  over  the  left  side,  will 
frequently  start  the  water. 

The  nutrient  enema.  For  giving  a  nutrient  enema,  a  piston 
syringe  is  generally  used,  but  the  enema  can  be  given  with  a 
fountain  syringe.  Glass  syringes  are  best,  as  they  can  be 
more  easily  cleaned.  Rubber  syringes  are  hard  to  clean,  and  as 
we  cannot  see  into  them  we  can  never  be  sure  that  they  are  clean. 
A  rectal  tube  is  used,  attached  to  the  point  of  the  syringe  or  to  a 
funnel.  The  position  of  the  patient  is  the  same  as  directed  in  the 
other  cases,  except  that  in  addition  it  is  well  to  elevate  the  hips 
by  placing  a  pillow  under  them.  After  the  fluid  has  been  inserted, 
if  there  is  any  inclination  to  expel  it,  press  against  the  rectum  with 
a  towel.  After  the  enema  has  been  given,  the  patient  is  turned  over 
on  the  right  side  and  left  with  the  hips  elevated. 

A  nutrient  enema  must  be  as  nearly  as  possible  at  the  temper- 
ature of  the  patient.  It  should  be  prepared  a  little  hotter  than 
it  is  to  be  given,  as  there  will  be  a  certain  amount  of  cooling  in  the 
passage  through  the  tube.  Lubricate  the  tube,  fill  the  funnel  or 
syringe,  and  then  insert  the  tube.  If  a  funnel  is  being  used,  open 
the  stopcock,  and  watch  the  funnel  to  see  that  it  does  not  become 
empty.  Continue  pouring  steadily  into  the  funnel  until  the 
prescribed  quantity  has  been  used.  Since  a  nutrient  enema  must 
be  given  very  slowly,  the  funnel  should  be  raised  only  high  enough 
above  the  patient's  body  to  allow  the  fluid  to  run.  If  a  syringe 
is  used,  the  pressure  on  the  piston  must  be  very  slow  and  steady. 
In  case  the  patient  complains  and  seems  to  have  difficulty  in  retain- 
ing the  fluid,  stop  and  press  a  towel  against  the  rectum,  and 
continue  the  treatment  when  the  intestine  becomes  quiet. 

If  the  distress  is  great,  it  is  much  better  to  give  only  a  part 


124          Personal  Hygiene  and  Home  Nursing 

of  the  enema  and  have  it  retained,  than  to  persist  in  giving  all 
and  then  have  it  rejected.  After  the  liquid  has  been  passed 
through  the  tube,  wait  a  minute  or  two,  then  slowly  remove  the 
tube  and  apply  pressure  to  the  rectum.  Turn  the  patient  on  the 
back  or  the  right  side,  with  hips  elevated. 

When  a  patient  is  fed  for  days  by  nutrient  enemas,  purgative 
enemas  must  be  given  at  least  once  a  day.  Some  part  of  the  food 
nearly  always  remains  unabsorbed,  and  this  must  be  removed, 
as  it  will  otherwise  form  gas  in  the  intestine  and  make  it  impossible 
for  the  patient  to  retain  the  nutrient  enema.  Washing  out  the 
bowels  at  least  once  a  day  with  soapsuds,  salt  water,  or  clear  water, 
an  hour  before  the  time  for  a  nutrient  enema,  will  prevent  its 
rejection  and  often  make  it  possible  for  the  patient  to  be  nourished 
for  a  much  longer  time  in  this  manner. 

If  the  rejection  of  an  enema  occurs,  do  not  conclude  that  it  is 
impossible  for  the  patient  to  retain  another,  but  try  to  get  at  the 
reason  for  the  failure.  The  enema  may  have  been  too  hot  or  too 
cold,  or  may  have  been  given  too  rapidly ;  or  there  may  have  been 
gas  or  feces  in  the  bowels,  or  the  time  may  have  been  too  long 
since  the  giving  of  the  last  purgative  enema. 

Medicinal  enemas.  Medicines  such  as  salts,  glycerin,  and 
turpentine  are  sometimes  ordered  as  enemas.  As  these  are  in- 
tended to  be  returned  immediately,  they  are  given  at  the  same 
temperature  as  the  purgative  enema,  105°  F.  Narcotics  and 
stimulants  and  medicines  of  starch,  oil,  or  other  soothing  substances 
are  sometimes  given  by  enema,  and  as  these  are  to  be  retained,  they 
are  given  by  the  same  method  as  a  nutrient  enema. 

Irrigating  the  bowels.  An  irrigation  differs  from  an  enema  in 
that  the  water  is  thrown  into  the  body  and  allowed  to  run  out 
immediately.  For  giving  an  irrigation,  use  a  fountain  syringe,  a 
rectal  tube  (page  122),  a  Y-shaped  piece  of  tubing  which  may  be 
either  of  glass  or  nickel,  and  a  piece  of  flexible  rubber  tubing  for 
the  return  flow.  Connect  the  rectal  tube  with  the  stem  of  the 
Y-tube,  the  syringe  with  one  fork,  and  the  escape  pipe  with  the 


Methods  of  Giving  Various  Treatments         125 

other  fork.    There  should  be  a  stopcock  on  both  the  tube  connected 
with  the  bag  and  the  escape  tube.     Hang  the  bag  higher  than  when 


Rectal  tube 


FIG.  55.     The  apparatus  needed  for  irrigating  the  bowels. 

giving  an  enema.     Use  the  same  care  in  running  off  the  cold  water, 
and  in  oiling  and  inserting  the  tube,  as  when  giving  an  enema. 

The  clear  water,  salt  water,  or  whatever  prescription  has  been 
ordered  by  the  physician,  is  prepared  in  a  pitcher  and  carried  to 
the  bedside.  It  must  be  of  a  temperature  from  110°  to  ii2°F. 
Use  from  two  to  six  quarts,  according  to  the  orders  of  the  physician 
or  the  necessity  of  the  patient,  watching  to  see  that  the  patient 
does  not  become  too  fatigued.  After  inserting  the  rectal  tube,  let 
about  a  quart  run  into  the  body,  then  close  the  stopcock  connected 
with  the  bag  and  open  the  one  connected  with  the  waste  tube,  the 
end  of  which  must  rest  in  a  bowl  or  slop  jar.  The  water  should 
run  back  from  the  body.  As  soon  as  this  return  flow  stops,  close 
the  waste  pipe  and  open  the  tube  connected  with  the  bag,  and 
let  in  water  until  about  a  pint  has  been  used,  or  until  the  patient 
is  uncomfortable.  Proceed  in  this  way,  allowing  the  water  to  run 
into  and  out  of  the  body,  until  it  returns  clear.  If  when  the  waste 
pipe  is  opened  the  water  does  not  return,  the  flow  may  be  started 
by  pushing  the  rectal  tube  in  a  little  farther  or  withdrawing  it  a 
little  bit.  Sometimes  the  flow  is  checked  by  a  slight  bend  of  the 


126          Personal  Hygiene  and  Home  Nursing 

tube  or  by  an  obstruction  that  closes  the  mouth  of  it ;  moving  the 
tube  will  usually  remedy  this. 

Douches  and  their  use.  A  douche  is  a  stream  of  water  directed 
against  a  part  to  cleanse  it,  to  reduce  congestion  and  inflammation 
in  it,  to  check  hemorrhage,  or  to  stimulate  the  nervous  system. 
Douches  are  of  various  kinds;  for  example,  spinal,  vaginal,  nasal, 
throat,  ear,  and  eye  douches.  They  are  given  hot,  cold,  or  medi- 
cated. 

Spinal  douches.  The  spinal  douche  is  given  to  relieve  nervous- 
ness and  insomnia.  It  is  usually  given  with  a  rubber  spray  attached 
to  the  faucet  of  the  bathtub ;  but  if  you  have  not  such  a  spray,  a 
pitcher  may  be  used  and  the  water  poured  down  the  spine.  Have 
the  patient  sit  upon  the  edge  of  the  bathtub,  while  you  spray  or 
pour  water  up  and  down  the  spine.  At  the  same  time  rub  her  back 
briskly  with  your  hand.  Cold  water  is  generally  used  for  this 
treatment,  but  if  the  patient  finds  this  too  severe,  warm  or  hot  water 
may  be  used. 

The  vaginal  douche.  The  vaginal  douche  is  given  with  a 
fountain  syringe  having  a  point  designed  for  that  purpose.  The 
temperature  is  from  110°  to  ii2°F.  for  cleansing  purposes,  and 
from  1 1 8°  to  120°  for  checking  hemorrhage  or  allaying  inflamma- 
tion. Use  from  two  to  three  quarts  of  water.  The  patient  is 
placed  on  her  back  on  a  douche  pan,  and  the  bag  is  hung  about  two 
feet  above  the  body.  The  air  should  be  expelled  from  the  tube 
before  inserting  it.  The  medicines  generally  used  are  normal  salt 
solution,  carbolic  acid  (i  part  to  120  parts  of  water),  boric  acid 
(2  per  cent),  creolin  (14  per  cent),  green  soap  (i^-  per  cent),  or 
clear  hot  water.  Douches  are  generally  ordered  by  the  physician, 
who  also  directs  the  medicine  which  should  be  used.  Be  careful 
that  the  bag  is  clean,  and  free  from  medicines  used  for  enemas  or 
other  purposes.  Wash  it  thoroughly  with  hot  water,  or  better 
still,  sterilize  it  by  boiling  before  giving  the  douche. 

Nasal  douches.  The  nasal  douche  is  used  perhaps  too  freely,  as 
the  constant  employment  of  a  spray  or  douche  frequently  causes 


Methods  of  Giving  Various  Treatments         127 

irritation  in  the  nasal  region ;  but  when  suffering  from  a  cold, 
one  should  clear  the  nostrils  with  a  douche. 

It  is  better  for  the  amateur  hot  to  use  a  spray,  for  the  spray 
forces  the  water  back,  and  frequently  carries  with  it  germs  from 
the  throat  into  the  Eustachian  tube  (page  53).  A  small  syringe, 
like  an  ear  syringe,  which  throws  back  a  gentle  stream,  can  be  used. 
One  way  of  douching  the  nose  is  to  prepare  the  solution  in  a  cup  or 
glass,  and  to  hold  the  glass  under  the  nose  and  drink  it  up  through 
the  nose.  Be  very  careful  about  blowing  the  nose  after  allowing 
the  fluid  to  run  into  it.  Closing  one  side  of  the  nostril  and  blowing 
violently  with  the  other  frequently  opens  the  Eustachian  tube  and 
forces  mucus  into  the  tube.  Blow  either  into  a  pus  pan  or  a  hand- 
kerchief, without  pressure  against  the  nose. 

If  one  nostril  is  closed  with  phlegm  and  the  other  open,  syringe 
through  the  closed  nostril,  so  that  the  fluid  can  escape  through 
the  open  nostril.  When  the  nose  is  sprayed  or  syringed  through 
the  open  nostril,  the  fluid  cannot  escape  and  it  lodges  back  of  the 
nose,  where  it  causes  irritation  and  may  be  carried  into  the  Eusta- 
chian tube.  One  of  the  most  common  causes  of  deafness  is  an 
irritation  of  this  tube  following  an  attack  of  grippe  or  cold,  or 
brought  on  by  the  violent  blowing  of  the  nose.  Try  not  to  swallow 
while  spraying,  as  in  the  act  of  swallowing,  the  mouth  of  the 
Eustachian  tube  is  opened.  Bend  the  head  forward,  keep  the 
mouth  open,  and  breathe  through  the  mouth.  To  aid  in  breathing 
through  the  mouth,  make  the  sound  of  e-e-e-e-e.  If  the  water  is 
too  cold,  and  causes  coughing,  the  syringing  'should  be  stopped. 

Ear  douches.  Great  care  must  be  taken  in  syringing  the  ear. 
Prepare  the  solution  at  a  temperature  of  from  100°  to  105°  F.  and 
inject  the  water  gently  into  the  ear.  A  fountain  syringe  with  the 
small  nozzle  attached  is  the  best  to  use.  The  nozzle  should  be 
put  at  the  edge  of  the  ear  and  not  forced  in  too  far.  Hold  the 
syringe  just  high  enough  to  allow  the  water  to  run,  and  let  the 
water  flow  gently  into  the  ear,  a  small  basin  being  held  close 
under  it  to  catch  the  overflow.  Dry  the  ear  with  absorbent  cotton. 


128          Personal  Hygiene  and  Home  Nursing 

Eye  douches.  Never  put  medicine  or  drops  in  the  eye  unless 
ordered  by  the  doctor,  but  washing  with  boric  acid  solution  is 
permissible  (page  71).  Always  wash  the  eye  by  movements 
directed  away  from  the  other  eye.  Nothing  is  more  infectious 
than  the  discharge  from  an  eye  that  is  inflamed ;  the  infection  may 
be  carried  from  one  person  to  another,  or  from  one  eye  to  the  other. 
Be  careful  (i)  to  hold  the  head  so  that  the  eye  to  be  syringed  is 
down,  (2)  to  syringe  away  from  the  other  eye,  and  (3)  to  catch  the 
fluid  in  a  piece  of  absorbent  cotton.  Never  use  the  same,  piece 
of  absorbent  cotton  for  both  eyes.  After  syringing  the  eye, 
wash  the  hands  most  carefully,  and  if  the  eye  is  infected  use  a 
disinfectant  for  the  hands.  For  some  reason,  when  working  over 
an  infected  eye  one  often  has  an  itching  sensation  in  one's  own 
eyes  and  a  desire  to  put  the  hands  to  them.  This  impulse  must 
be  sternly  repressed. 

Counter-irritants.  By  a  counter-irritant  we  mean  anything, 
hot  or  cold,  applied  to  the  skin,  which  helps  to  draw  the  blood  to 
the  surface.  One  of  the  simplest  counter-irritants  in  use  is  the  hot- 
water  bag.  In  using  this,  the  water  must  be  hot  but  not  boiling. 
A  bag  filled  with  boiling  water  will  sometimes  burst  and  burn  the 
patient  badly,  It  is  well  not  to  fill  the  bag  too  full.  Be  sure 
that  it  does  not  leak  and  that  the  cork  is  perfectly  tight.  The 
bag,  especially  when  applied  to  an  unconscious  patient,  should  be 
completely  covered  with  flannel.  Some  persons,  after  an  operation 
or  when  unconscious,  have  been  burned  with  hot-water  bags.  In 
the  majority  of  such'cases  it  is  the  fault  of  an  untrained  assistant. 
Nurses  in  training  are  taught  that  when  a  hot-water  bag  is  put 
beside  an  unconscious  patient  it  must  be  wrapped  carefully  and 
in  addition  have  at  least  one  thickness  of  blanket  between  it  and 
the  patient.  The  air  should  be  pressed  out  of  a  hot-water  bag 
before  using,  as  this  makes  it  soft  and  not  so  likely  to  burst.  In 
home  nursing  it  is  wise  to  have  two  or  three  hot-water  bags  for  use 
in  emergencies.  If  this  is  not  possible,  a  hot  brick  or  flatiron,  or  a 
bag  of  sand  heated  on  a  radiator  or  in  a  very  moderate  oven  and 


Methods  of  Giving  Various  Treatments         129 

inclosed  in  flannel,  can  be  used  to  supplement  the  hot-water  bag 
and  keep  the  feet  warm  when  the  rubber  bag  is  needed  for  some 
other  part  of  the  body. 

Poultices.  Poultices  are  not  used  as  much  as  they  formerly 
were,  and  are  not  used  at  all  for  abscesses,  as  it  is  now  believed 
that  they  keep  the  tissues  warm  and  moist  and  make  conditions 
favorable  for  the  development  of  the  germs.  They  are  occasionally 
ordered  in  cases  of  pneumonia,  or  for  the  abdomen.  They  are 
usually  made  of  flaxseed.  The  water  must  be  boiling  before  the 
meal  is  added,  and  enough  meal  should  be  used  to  make  the  mixture 
thick  enough  to  drop  clean  from  the  spoon.  A  teaspoonful  of 
soda  added  to  half  a  pint  of  water  helps  to  make  the  poultice 
light.  After  mixing  the  materials  for  the  poultice  thoroughly 
over  the  fire,  take  them  off  and  beat  them  until  they  are  light.  Be 
sure  that  the  cloth  is  large  enough  to  cover  the  poultice  and  fold 
it  well  over  at  the  edges.  The  quantity  of  mixture  to  be  put  upon 
the  cloth  must  depend  upon  the  condition  and  part  of  the  body  to 
which  the  poultice  is  to  be  applied.  For  example,  for  an  abdominal 
poultice  it  should  be  spread  rather  thin,  particularly  if  there  is 
excessive  pain  or  inflammation  in  the  abdominal  walls  or  organs. 

Be  very  careful  not  to  apply  a  poultice  hot  enough  to  burn  the 
patient,  as  it  is  easy  to  blister  the  skin  in  this  way.  Test  the  heat 
by  laying  the  poultice  against  your  cheek  or  a  tender  part  of  the 
arm.  After  laying  the  poultice  on  the  body,  cover  it  with  oiled 
silk,  folds  of  flannel,  or  a  towel.  When  it  becomes  cool,  take  it 
off  and  cover  with  flannel  the  part  where  it  was  applied. 

Digitalis  poultices  are  made  as  follows :  Take  two  ounces  of  the 
digitalis  leaves  to  a  pint  of  water,  boil  for  fifteen  minutes,  strain 
out  the  leaves,  and  use  the  water  for  making  a  flaxseed  poultice  as 
directed  above. 

Mustard  plasters  are  made,  for  adults,  by  mixing  together  one 
part  of  mustard  to  eight  parts  of  flour  and  stirring  this  mixture  in 
water.  For  children,  one  part  of  mustard  to  sixteen  parts  of  flour  is 
used.  Mustard  plasters  should  be  left  on  from  five  to  ten  minutes 


130          Personal  Hygiene  and  Home  Nursing 

only,  according  to  the  amount  of  irritation  needed  and  according  to 
the  sensitiveness  of  the  skin  of  the  patient.  Ready-prepared 
mustard  plasters  are  convenient.  As  they  are  very  hot,  the  skin 
should  be  slightly  oiled  to  prevent  blistering ;  and  after  they  are 
taken  off,  the  skin  must  be  washed. 

Stupes.  Cloths  wrung  out  of  hot  water  are  called  stupes.  The 
water  is  frequently  mixed  with  turpentine.  Never  make  the 
mistake  of  sprinkling  the  turpentine  on  the  flannel.  It  should 
be  mixed  with  a  little  olive  oil  and  then  with  the  water.  This 
keeps  it  from  blistering  the  skin.  In  making  a  stupe,  use  a  piece 
of  flannel  three  times  as  large  as  the  area  of  skin  to  be  covered. 
This  must  be  dipped  in  water  so  hot  that  it  is  impossible  to  wring 
out  the  flannel  with  the  hands.  It  can  be  wrung  out  by  placing 
it  in  the  middle  of  a  towel,  dipping  the  towel  in  the  water  and 
wringing  it  out  by  holding  the  two  ends  of  the  towel ;  but  if  the 
stupes  are  to  be  continued  for  a  long  time,  it  is  simpler  to  make  a 
stupe  wringer.  This  is  done  by  taking  a  piece  of  unbleached 
muslin,  with  wide  hems  at  the  ends,  and  inserting  a  stick  into 
each  of  these  hems.  The  flannel  is  placed  in  the  middle  of  the 
cloth,  and  the  wringer  is  held  by  the  sticks  and  twisted. 

The  doctor  may  order  turpentine  stupes  to  be  applied  for  ten  or 
fifteen  minutes.  By  this  he  means  that  you  are  to  change  the 
stupes,  removing  one  as  it  cools  and  putting  on  another,  and  con- 
tinuing this  for  from  ten  to  fifteen  minutes.  It  is  customary  to 
Vary  turpentine  stupes  with  those  of  plain  water,  as  too  much  tur- 
pentine may  blister.  At  the  end  of  the  ten  or  fifteen  minutes  the 


FIG.  56.    A  stupe  wringer. 


Methods  of  Giving  Various  Treatments         131 

skin  must  be  dried,  and  warm  flannel  or  warm  absorbent  cotton 
laid  over  it.  In  putting  on  stupes  the  flannel  is  shaken  out,  laid 
in  loose  folds,  and  then  covered  with  oiled  muslin,  a  towel,  or  a 
piece  of  flannel. 

Hot  and  cold  compresses.  Compresses  are  pieces  of  gauze, 
absorbent  cotton,  or  old  muslin,  which  have  been  wet  in  either  hot 
or  cold  water.  They  are  applied  to  any  part  of  the  body  where 
there  is  acute  inflammation.  They  are  applied  for  fifteen  minutes 
at  intervals  throughout  the  day,  and  must  be  changed  frequently. 
Sometimes  both  hot  and  cold  compresses  are  used,  a  cold  compress 
being  applied  first,  then  hot  and  cold  alternating  for  fifteen  minutes. 
When  applying  compresses  to  an  affected  eye,  use  the  same  care 
for  your  patient  and  yourself  that  you  do  in  douching  the  eye,  never 
using  the  same  compress  on  the  two  eyes  and  taking  care  not  to 
touch  your  own  eyes  with  your  fingers.  One  general  principle 
that  applies  to  everything  used  for  bandages,  compresses,  or 
poultices  is  that  the  cloths  used  must  be  clean. 


CHAPTER   EIGHTEEN 

COMMUNICABLE  DISEASES 

FOR  a  long  time  a  distinct  line  was  drawn  between  contagious 
and  infectious  diseases.  It  was  supposed  that  a  contagious  disease 
was  communicated  by  direct  contact,  while  an  infectious  disease 
was  "  in  the  air,"  and  might  be  contracted  without  touching  any 
person  or  article  infected.  These  terms  are  now  used  inter- 
changeably, and  are  considered  to  mean  practically  the  same  thing. 
Physicians  prefer  the  word  communicable  as  covering  all  classes  of 
diseases  in  which  the  germs  of  the  disease  are  carried  from  one 
person  to  another. 

The  germs  of  some  diseases  are  transferred  directly  by  contact, 
or  on  articles  touched  by  infected  hands ;  in  other  cases  they  travel 
indirectly  through  water,  food,  or  air;  and  sometimes  they  are 
communicated  through  the  bites  of  insects.  Before  the  agency  of 
the  mosquito  and  other  insects  in  the  spread  of  infection  was  under- 
stood, the  mysterious  rapidity  of  the  spread  of  such  a  disease  as 
yellow  fever  and  bubonic  plague  naturally  led  to  the  belief  that  the 
very  air  was  poisoned ;  and  until  it  was  found  that  certain  germs 
are  conveyed  in  water,  it  was  not  understood  how  a  single  case 
of  typhoid  fever  might  cause  an  epidemic  in  a  town  miles  away. 

Channels  of  infection.  There  are  four  common  channels  through 
which  the  germs  of  communicable  diseases  enter  the  body : 

(1)  Through  the   alimentary  tract,  as  in   typhoid  fever,  dys- 
entery, cholera,  and  sometimes  tuberculosis. 

(2)  Through  the  respiratory  passages,  as  in  pneumonia,  tuber- 
culosis, diphtheria,  influenza,  measles,  and  scarlet  fever. 

(3)  By  direct  inoculation  from  the  bite  of  an  insect  which  conveys 
the  germ  into  the  blood,  as  in  malaria,  yellow  fever,  and  plague. 

(4)  Through  cuts  and  wounds,  as  in  tetanus  (lockjaw),  anthrax, 
and  infection  of  wounds  with  pus-forming  bacteria. 

Public  control  of  communicable  diseases.  In  many  cities  and 
states  the  attending  physician  is  required  to  report  any  case  of 
communicable  disease  to  the  board  of  health.  On  the  receipt  of 

132 


Communicable  Diseases  133 

this  report  an  inspector  is  sent  to  the  house,  who  inspects  all  the 
surroundings,  including  the  patient's  room.  Inquiries  are  made 
into  the  system  of  disinfection  and  isolation  used,  and  if  the.  disease 
is  considered  infectious  to  a  degree  endangering  the  public,  the 
house  is  posted.  Thus  the  question  of  isolation  for  the  purpose 
of  controlling  the  germ  is  not  left  to  the  individual  but  is  enforced 
by  law.  Nurses  taking  care  of  such  cases  are  required  to  keep 
themselves  separate  from  other  persons.  In  some  cities  those 
living  in  the  same  house  as  a  patient  suffering  from  scarlet  fever, 
diphtheria,  or  smallpox  are  forbidden  to  go  into  public  buildings. 

Supplementing  such  laws  are  laws  controlling  food  distribution 
and  supply.  The  health  of  those  who  handle  milk  and  other  food 
is  investigated,  and  the  source  of  the  supplies  inspected.  Various 
means  are  taken  to  secure  milk  and  other  food  free  from  infection, 
and  thus  prevent  the  spread  of  communicable  diseases.  Milk 
bottles  are  not  allowed  to  be  taken  from  a  house  where  a  communi- 
cable disease  exists.  The  two  important  methods  of  preventing 
the  spread  of  infections  are  to  isolate  the  patient  and  to  destroy 
by  disinfection  the  germs  that  come  from  the  patient. 

Isolation.  The  most  important  measure  in  the  control  of 
communicable  diseases  is  isolation,  but  to  be  effective  this  must  be 
complete  and  must  be  continued  until  all  danger  of  the  patient 
giving  the  disease  to  others  is  past.  When  this  time  comes  the 
patient  should  be  bathed  with  a  disinfectant,  have  the  hair  washed, 
and  be  provided  with  clean  clothing  before  leaving  the  room.  A 
diphtheria  patient  should  be  kept  isolated  until  the  cultures  from 
the  throat  are  returned  negative.  The  period  of  isolation  is 
prescribed  by  the  physician  in  charge  and  by  the  board  of  health.  A 
patient  should  not  be  allowed  to  come  out  of  the  room  or  mingle 
with  the  family  until  permission  to  do  so  has  been  definitely  given. 

Many  persons  are  careless  about  traveling  during  convalescence. 
We  should  be  sure,  before  entering  trains  and  hotels,  that  there  is 
absolutely  no  danger  of  carrying  a  disease.  In  one  case  a  child 
convalescing  from  scarlet  fever  was  taken  in  a  Pullman  car  to  a 


134          Personal  Hygiene  and  Home  Nursing 

summer  resort.  Extreme  illness  and  even  death  resulted  from  the 
infection  spread  among  the  passengers,  and  the  summer  resort 
eventually  had  to  be  closed  early  in  the  season,  to  the  serious 
financial  loss  of  those  depending  on  it  for  their  income. 

Disinfectants.  Fire,  hot  water,  and  sunlight  are  three  of  the 
surest  disinfectants  that  are  usually  available,  but  for  some  pur- 
poses these  cannot  be  conveniently  used  and  chemical  disinfectants 
are  employed.  Some  of  these  are  better  for  one  purpose  and  some 
for  another.  The  following  list  includes  those  most  commonly 
used  and  indicates  the  purposes  for  which  each  is  most  suitable : 

Bichlorid  of  mercury,  a  common  and  easily  obtained  disinfectant, 
should  not  be  used  for  disinfecting  animal  excreta ;  that  is,  it  is  not 
suitable  for  use  in  cases  of  typhoid  fever  or  other  diseases  where  the 
bowel  discharges  are  to  be  disinfected,  and  it  is  not  as  good  as  some 
other  disinfectants  for  use  on  the  sputum  of  a  consumptive.  It 
is  injurious  to  toilet  bowls  and  pipes,  and  stains  white  clothing.  It 
must  not  be  used  in  a  metal  vessel.  If  used  constantly,  it  may  be 
injurious  to  the  skin.  It  is  useful  for  disinfecting  glass,  washing 
paint,  or  cleaning  enameled  ware. 

Carbolic  acid  is  the  best  general  disinfectant  to  use  in  an  in- 
fectious case.  The  proportion  should  be  one  part  of  the  acid  to 
thirty-nine  parts  of  water.  It  should  be  made  up  with  hot  water 
and  thoroughly  dissolved  in  the  water.  It  neither  stains  the  clothes 
nor  injures  piping.  The  objections  to  it  are  that  care  must  be 
taken  in  its  preparation,  as,  if  not  thoroughly  mixed,  it  may  burn 
the  skin ;  that  if  used  too  strong  it  may  cause  a  feeling  of  numbness 
or  produce  sores ;  and  that  many  persons  object  to  its  odor. 

Disinfectants  such  as  cresol,  lysol,  creolin,  and  other  coal-tar 
derivatives  are  good,  but  may  be  more  expensive  than  carbolic  acid. 
Formalin  is  a  solution  of  formaldehyde  gas  in  water.  It  is  non- 
poisonous  and  does  not  injure  silk  or  wool,  but  it  gives  off  a  gas 
which  is  very  irritating  to  the  mucous  membrane,  and  to  which 
some  persons  are  especially  sensitive.  It  must  be  very  carefully 
used,  particularly  in  diseases  where  the  throat  and  nose  are  affected. 


Communicable  Diseases  135 

Biniodid  of  mercury  is  twice  as  strong  as  bichlorid  of  mercury 
and  is  therefore  used  at  half  the  strength.  It  can  be  used  with 
metals  and  does  not  injure  the  hands. 

Alcohol  can  be  used  as  a  quick  disinfectant  for  the  hands,  but 
if  used  too  often  it  will  dry  the  cuticle  and  may  cause  fissures  in 
the  skin. 

Listerin  is  a  convenient  disinfectant  for  the  mouth,  throat,  and 
hands.  It  contains  boric  acid,  alcohol,  and  other  ingredients. 
For  use  in  the  mouth  it  should  be  diluted,  using  one  part  of  listerin 
to  two  of  water.  For  the  hands  it  can  be  used  pure. 

It  is  always  to  be  remembered  that  the  germs  of  all  our  ordinary 
diseases  are  killed  practically  at  once  by  boiling  water,  and  that 
where  they  are  not  protected  by  something  over  them,  strong 
sunlight  is  almost  instantly  fatal  to  them.  Clothing  can  often 
be  disinfected  by  boiling,  more  easily  than  in  any  other  way,  and 
chairs  and  other  articles  of  furniture  can  be  made  safe  by  placing 
them  in  the  sun.  It  should  be  understood,  however,  that  light 
which  has  passed  through  glass  has  lost  its  disinfecting  power. 

Disinfection  of  rooms.  In  most  cities  the  board  of  health  takes 
charge  of  the  disinfection  of  sick  rooms  after  the  patient  is  dis- 
charged from  quarantine.  Where  the  health  authorities  do  not  do 
this,  and  a  member  of  the  family  wishes  to  disinfect  a  room  with 
gas,  she  should  first  open  all  closet  doors,  close  the  fireplace, 
registers,  and  windows,  and  stop  all  cracks  by  pasting  paper 
over  them  or  stuffing  raw  cotton  into  them.  The  gas  can  be 
generated  by  placing  a  washtub  in  the  center  of  the  room  and 
setting  in  it  a  galvanized-iron  pail.  Then  put  into  the  pail  for 
each  1000  cubic  feet  of  space  of  air  in  the  room  250  grains  (9 
ounces)  of  potassium  permanganate  and  pour  over  the  per- 
manganate for  each  1000  cubic  feet  of  space  500  cc.  of  formalin 
(40  per  cent).  Be  ready  to  leave  the  room  at  once,  as  a  great 
volume  of  formaldehyde  gas  will  be  immediately  given  off.  Close 
the  door  through  which  you  go  out,  paste  paper  over  the  cracks 
about  it,  and  leave  the  room  shut  up  for  twenty-four  hours.  Then, 


136          Personal  Hygiene  and  Home  Nursing 

covering  the  nose  and  keeping  the  eyes  closed,  go  directly  to  the 
windows  and  open  them  and  allow  the  room  to  air  for  several 
hours  before  attempting  to  clean  it.  It  is  a  good  plan,  in  prepar- 
ing the  room,  to  push  all  furniture  out  of  the  way,  leaving  an 
unobstructed  path  to  the  window. 

In  some  places  formaldehyde  gas  is  not  considered  efficacious, 
and  the  method  used  for  disinfection  is  to  wash  the  floors  with  a 
disinfectant  solution  and  paint  them,  and  where  possible,  to 
treat  the  walls  of  the  room  in  the  same  way.  Then  leave  the  room 
open  for  several  days  to  the  sunlight  and  wind.  It  is  well  to  use 
this  last  method,  even  when  gas  has  been  used,  for  it  is  more  certain 
to  achieve  the  desired  results. 

Contacts,  mild  cases,  and  healthy  carriers  of  disease  germs. 
When  a  disease  of  an  infectious  nature,  such  as  diphtheria,  measles, 
or  scarlet  fever,  occurs  in  a  school,  all  children  who  have  come  in 
contact  with  the  child  who  is  taken  ill  should  be  thoroughly 
examined  by  a  physician ;  and  if  germs  are  found  or  if  there  is  an 
indication  of  cold  or  sickness  of  any  kind,  the  child  should  be  kept 
from  school  until  well.  In  very  infectious  diseases  like  measles,  the 
child  should  be  isolated  even  before  the  symptoms  appear,  for  it 
is  practically  certain  that  the  disease  will  develop. 

Another  problem  in  the  control  of  communicable  diseases  is  that 
of  unrecognized  cases  of  these  diseases  and  of  healthy  carriers  of 
virulent  germs.  It  sometimes  happens  that  an  infectious  disease 
takes  a  form  so  mild  that  a  physician  is  not  called,  and  the 
nature  of  the  disease  is  not  discovered.  In  such  a  case,  of  course, 
nothing  is  done  to  prevent  the  spread  of  the  germs,  and  a  per 
son  exposed  to  contagion  by  a  mild  case  may  have  the  disease  in 
a  violent  form. 

Disease  germs  may  also  be  spread  through  persons  called 
"  carriers,"  or  hosts  of  disease  germs,  who  may  either  have  had 
the  disease  themselves  or  may  have  been  in  close  contact  with  some 
one  who  had  it.  After  convalescence  from  some  diseases  the  germs 
may  remain  in  the  body  for  months  or  years,  and  while  the  carrier 


Communicable  Diseases  137 

may  seem  to  have  recovered  he  may  still  give  the  disease  to  those 
who  come  in  contact  with  him.  In  some  persons  the  germs  are 
so  persistent  that  they  cannot  be  destroyed  by  treatment.  This  is 
especially  true  of  carriers  of  typhoid  fever.  Such  persons  should 
not  be  allowed  to  cook  or  distribute  food  to  others,  and  should  be 
strictly  clean  in  all  their  habits,  particularly  in  washing  and  dis- 
infecting their  hands  after  going  to  the  toilet. 

Still  another  class  of  carriers  is  found  among  healthy  persons 
who  have  been  in  contact  with  those  sick  from  certain  infectious 
diseases.  A  considerable  number  of  those  who  are  in  contact 
with  diseases  like  diphtheria,  meningitis,  pneumonia,  and  poliomye- 
litis (infantile  paralysis)  carry  the  germs  in  their  noses  and  throats, 
although  they  themselves  show  no  indication  of  the  disease.  These 
carriers  are  the  chief  problem  in  the  control  of  certain  diseases, 
and  if  the  disease  is  to  be  kept  from  spreading,  they  must  be  isolated 
until  they  are  free  from  the  germs.  It  is,  therefore,  necessary  to 
give  attention  to  other  persons  besides  those  who  are  actually  ill 
of  communicable  diseases  if  we  wish  to  hold  these  diseases  in  check. 

Avoiding  unnecessary  exposure  to  disease.  No  one  should  be 
exposed  to  a  communicable  disease  unnecessarily.  It  is  not  to  be 
assumed  that  because  the  person  suffering  from  the  disease  has  it 
in  a  mild  form,  or  because  the  person  exposed  is  in  excellent  phys- 
ical condition,  the  disease  will  be  transmitted  in  a  mild  form.  If 
enough  germs  are  taken  into  the  body  to  result  in  the  disease,  it 
may  take  a  violent  form,  and  previous  good  health  may  not  pre- 
vent serious  complications  and  even  death.  If  called  upon  to 
nurse  such  a  case,  undertake  it  with  courage  and  confidence  and 
take  all  means  to  prevent  contagion.  But  no  one  should  unneces- 
sarily court  infection,  because  even  if  the  disease  is  not  contracted 
by  the  person  exposed,  the  germs  may  be  carried  to  others  on  the 
clothing  or  the  hands.  The  fewer  the  number  of  persons  exposed 
to  a  disease,  the  smaller  the  number  of  germ  carriers  and  new  cases 
there  will  be. 


CHAPTER   NINETEEN 

NURSING   COMMUNICABLE  DISEASES 

IN  nursing  non-communicable  diseases,  the  nurse  thinks  only 
of  the  welfare  of  the  patient.  In  nursing  a  communicable  disease 
she  has  the  double  task  of  caring  for  the  patient  and  of  keeping 
the  infection  from  spreading  to  herself  and  others.  In  this  chapter 
I  shall  give  some  general  instructions  that  apply  in  nursing  cases 
of  most  communicable  diseases,  and  in  subsequent  chapters  shall 
discuss  in  more  detail  particular  problems  that  arise  in  connection 
with  some  of  the  more  important  of  these  diseases.  Since  a  large 
proportion  of  the  illness  that  comes  into  the  ordinary  home  is  due 
to  communicable  diseases  of  one  kind  or  another,  a  knowledge  of 
them  will  prove  most  valuable  to  the  amateur  nurse  in  her  home. 

Making  isolation  effective.  Isolation  which  is  not  complete 
is  not  really  isolation,  for  a  chain  is  no  stronger  than  its  weakest 
link.  It  is  important,  therefore,  that  in  case  of  a  communicable 
disease  the  room  chosen  for  the  sick  room  should  be  separated  as 
far  as  possible  from  those  used  by  other  members  of  the  family. 
When  practicable,  the  best  arrangement  is  two  rooms  and  a  bath 
on  the  top  floor.  It  is  most  desirable  that  a  bathroom  should  be 
reserved  for  the  use  of  the  patient  and  nurse,  but  of  course,  in  a 
house  where  there  is  only  one  bathroom,  this  is  out  of  the  question. 
In  such  circumstances,  the  nurse  should  use  every  means  in  her 
power  to  avoid  infecting  the  bathroom  with  the  germs.  She  should 
not  set  a  vessel  on  the  floor  of  the  bathroom,  and  should  touch 
nothing  in  the  room  without  disinfecting  her  hands.  She  may 
use  a  piece  of  soft  paper  between  her  hand  and  the  faucets  and 
chain.  The  room  chosen  for  the  patient  should  be  easy  to  venti- 
late, and  if  possible  should  have  a  fireplace.  The  fireplace  not 
•  only  aids  in  ventilation,  but  affords  a  convenient  way  of  destroying 
paper  and  pieces  of  linen  or  gauze  which  have  been  used  in  the  care 
of  the  patient. 

The  nurse  in  charge  of  the  case  should  not  go  into  other  parts 
of  the  house,  or  mingle  with  other  members  of  the  family.  She 

138 


Nursing  Communicable  Diseases  139 

should  stay  in  the  sick  room  except  when  she  leaves  it  for  her 
daily  walk.  She  should  keep  outside  the  room  a  complete  suit 
of  outdoor  clothing,  even  to  shoes,  and  change  to  this  when  going 
for  her  walk,  and  she  should  pass  directly  out  without  stopping 
to  talk  with-  members  of  the  household. 

The  same  precautions  should  be  taken  by  any  member  of  the 
family,  or  any  friend,  who  may  be  called  upon  to  relieve  the  person 
in  charge  of  the  case.  The  hair  should  be  covered  while  in  the 
sick  room,  and  washed  afterward,  for  safety.  No  letters  should 
be  sent  from  the  sick  room  unless  they  are  disinfected.  After 
leaving  the  case  the  nurse  should  immediately  disinfect  herself 
and  wash  her  hair,  before  entering  street  cars  or  stores. 

Preparation  of  the  sick  room.  Remove  from  the  room  all 
unnecessary  rugs,  ornaments,  pictures,  and  books.  Clean  out 
the  closets  thoroughly  and  take  out  of  them  all  unnecessary  con- 
tents, especially  woolen  clothes  and  books.  In  selecting  the 
furniture  for  the  room,  choose  the  most  simple  and  the  most  easily 
disinfected.  In  many  diseases,  as  in  scarlet  fever  and  diphtheria, 
it  is  necessary  to  wash  off  the  beds  with  disinfectants.  A  brass 
bed  is  injured  by  water,  while  a  wooden  bed,  or  better  still  an  iron 
bed,  can  be  washed  and  thoroughly  disinfected.  The  preparation 
of  the  room  is  often  left  to  the  members  of  the  family,  for  by  the 
time  the  nurse  reaches  a  case  the  patient  has  frequently  been  in 
the  room  so  long  that  it  is  impossible  to  remove  the  things  left 
in  it. 

Disinfection  during  the  disease.  Floors  and  furniture  in  the 
sick  room  should  be  wiped  with  a  damp  cloth.  Dishes  used  should 
be  thoroughly  disinfected  before  being  taken  from  the  room,  and 
should  be  kept  separate  from  those  used  by  the  family.  All  food 
left  by  the  patient  on  the  plates  should  be  destroyed.  If  there  is 
a  fireplace  in  the  room,  the  surplus  food  should  be  burned ;  if  not, 
it  should  be  left  to  stand  in  a  disinfectant,  after  which  it  may  be 
safely  taken  from  the  room.  A  wooden  tub  filled  with  disinfectant 
solution  should  be  kept  outside  the  door,  where  a  maid  or  a  member 


140          Personal  Hygiene  and  Home  Nursing 

of  the  family  can  get  at  it.  Into  this  the  nurse  should  put  the 
dishes,  which,  after  having  stood  in  the  solution  for  at  least  an  hour, 
can  be  taken  away  by  the  maid.  When  this  is  done,  the  nurse 
does  not  have  to  touch  them  after  they  are  disinfected. 

The  same  means  can  be  used  in  disinfecting  clothes;  or  they 
may  be  wrapped  in  a  sheet  wet  with  a  disinfecting  solution,  carried 
to  the  laundry,  and  boiled.  Everything  that  touches  the  patient 
or  the  bed  should  be  disinfected.  The  solution  to  use  for  clothes, 
except  in  a  case  of  infantile  paralysis,  is  carbolic  acid  (5  per  cent) 
or  formalin  (10  per  cent).  The  nurse's  clothes  also  should  be 
disinfected. 

As  it  is  no  longer  believed  that  the  germs  of  such  diseases  as 
scarlet  fever  and  diphtheria  can  be  carried  through  the  air  or  in 
dust,  hanging  a  wet  sheet  over  the  door  is  not  .thought  necessary. 
Infection  is  most  commonly  conveyed  by  direct  contact  with  the 
patient  or  something  touched  by  the  patient,  such  as  bedclothes 
or  dishes.  The  nurse  may  convey  infection  in  working  over  the 
patient,  touching  the  body  with  her  hands  or  clothes,  or  soiling 
them  with  excreta  containing  germs.  But  if  the  proper  disinfect- 
ing of  all  infected  matter  has  been  done,  and  if  the  nurse  has  been 
properly  careful  in  carrying  excreta  from  the  room,  the  furniture 
and  rugs  on  the  opposite  side  of  the  room  from  the  patient  will 
be  only  slightly  infected,  and  the  few  germs  existing  will  be  de- 
stroyed by  fresh  air  and  sunshine. 

Disinfecting  excreta.  All  such  excreta  as  stools,  urine,  and 
sputum  should  be  disinfected.  Sputum  can  be  received  in  old 
linen,  paper  napkins,  or  paper  cups,  and  burned.  In  a  room 
where  there  is  no  fireplace  and  the  cloths  or  cups  must  be  carried 
out  of  the  room  to  be  burned,  the  nurse  should  wrap  them  in  a 
newspaper.  Some  member  of  the  family  may  receive  the  bundle 
from  her,  not  touching  it  with  the  hands,  but  folding  it  in  fresh 
paper,  and  carrying  it  down  to  be  burned  in  the  furnace  or  range. 

Fecal  discharges  may  be  disinfected  with  5  per  cent  carbolic 
acid,  cresol  (one  part  to  four  parts  of  water),  formalin  (10  per 


Nursing  Communicable  Diseases 


141 


cent),  or  chlorid  of  lime.    The  excreta  should  be  thoroughly 

covered  with  the  solution,  the  masses  broken  up,  and  the  solution 

stirred  into  it,  and  should  stand 

for  at  least  an  hour  in  a  covered 

vessel.     If    the  disinfectant  is 

applied  hot,  it  will  penetrate 

more  thoroughly. 

Protection  for  the  nurse.  A 
nurse  must  invariably  disinfect 
her  hands  after  working  with  ^  s?  A  face  mask  wom  in  nursing 

the  patient,   both   for   her  Own    cases  of  communicable  respiratory  diseases. 

sake  and  to  prevent  the  spread   Jt  fa  made  of  thre3  Plies  of  **"&  woven 

e  *.!_«.     j.1.  gauze  (bleached  absorbent  bandage  gauze, 

of    germs    through    the   room.    thread  count  44_4o)  which  is  known  as 

She   should   keep  ready  a  bowl  "butterdoth."    Such  masks  have  proved 

containing    a    disinfectant,   and  verv  effective  in  preventing  the  spread  of 

.,  ,  .  A,  ..  respiratory  infections, 

after  working  over  the  patient 

or  coming  in  contact  with  the  bed  or  the  person,  should  go  at 
once,  before  touching  anything  else  in  the  room,  and  disinfect 
her  hands.  When  the  disease  is  one  of  the  throat  or  lungs, 
she  should  constantly  use  a  gargle  and  mouth  wash.  If  the 
disease  is  diphtheria,  she  should  be  given  antitoxin,  unless  she  has 
been  tested  and  found  immune  to  the  disease ; l  if  she  is  caring  for 
a  case  of  smallpox,  she  should  be  vaccinated;  if  the  patient  has 
typhoid  fever,  the  nurse  should  be  made  immune  by  inoculation. 
She  should  eat  nothing  that  has  been  standing  in  her  own  room, 
and  should  not  eat  in  the  room  where  the  patient  is.  Before 
beginning  to  eat,  she  should  wash  out  her  mouth  and  throat,  and 
bathe  her  hands,  face,  and  arms  in  a  disinfectant.  In  working 
over  the  patient  she  should  not  allow  the  breath  of  the  sick  person 
to  come  in  her  face.  One  of  the  great  dangers  in  diphtheria  is  that 

'About  50  per  cent  of  all  persons  are  naturally  immune  to  diphtheria,  and  by  a 
test  called  the  Schick  reaction  it  is  now  possible  to  determine  who  is  immune  and  who 
is  not.  The  test  consists  in  injecting  with  a  hypodermic  needle  a  very  small  amount 
of  toxin  into  the  skin.  If  the  person  is  immune,  a  red  spot  appears  around  the  point 
of  injection. 


142          Personal  Hygiene  and  Home  Nursing 

the  patient  may  cough  in  the  face  of  the  nurse  while  she  is  spray- 
ing or  treating  the  throat  or  while  she  is  leaning  over  the  bed. 
At  such  times  she  should  wear  a  mask  of  fine  gauze. 

Daily  care  of  the  patient.  The  patient  should  be  bathed  once 
or  twice  daily.  Unless  the  skin  is  inflamed,  alcohol  may  be  added 
to  the  water.  In  cases  where  there  is  desquamation  (scaling), 
as  in  scarlet  fever  and  measles,  it  is  well  to  rub  the  body  with 
carbolated  vaselin  before  the  bath.  The  vaselin  not  only  relieves 
the  itching,  but  keeps  the  particles  of  skin  from  flying  about. 
The  mouth  and  tongue  should  be  cleaned  thoroughly  twice  a  day, 
and  oftener  if  there  is  excessive  fever.  A  mouth  wash  of  glycerin, 
boric  acid,  listerin,  and  water  will  help  to  keep  fissures  from  form- 
ing on  the  tongue.  Vaselin  should  be  put  on  the  lips  if  there  is  a 
tendency  to  dryness.  The  ears  should  be  watched  for  discharge, 
and  if  there  is  discharge  or  any  apparent  deafness  it  should  be 
reported  to  the  doctor.  Urine  should  be  measured  and  its  char- 
acter noted.  The  back  should  be  rubbed  twice  daily  to  prevent 
sores.  The  eyes  should  be  shielded  from  the  light  and,  if  they 
become  inflamed,  should  be  washed  out  with  a  saturated  solution 
of  boric  acid.  The  patient  should  not  be  left  alone,  for  there  is 
often  great  prostration  and,  in  most  communicable  diseases,  a 
danger  of  heart  failure. 

Complications.  In  all  infectious  diseases  certain  complications 
peculiar  to  the  disease  must  be  guarded  against,  and  their  pre- 
vention depends  in  the  main  upon  careful  nursing.  Even  in  mild 
attacks,  unfailing  care  and  attention  are  needed.  The  nurse 
should  keep  her  eyes  constantly  open  for  new  symptoms  and  re- 
port every  unusual  condition  to  the  physician.  She  should  inform 
herself  at  the  outset  as  to  the  complications  most  likely  to  occur, 
and  the  best  means  for  preventing  them.  Sometimes  the  best 
efforts  cannot  keep  these  complications  from  developing,  but  in 
the  majority  of  cases  intelligent  and  faithful  care  will  do  the 
work.  In  later  chapters  some  of  the  complications  to  be  looked 
for  in  some  important  diseases  will  be  pointed  out. 


CHAPTER   TWENTY 
SOME   COMMON  COMMUNICABLE  DISEASES 

THE  object  of  this  chapter  is  not  to  prescribe  the  treatment 
for  various  communicable  diseases,  enabling  readers  to  care  for 
their  sick  without  the  attendance  of  a  physician,  but  rather  to 
make  clear  the  importance  of  calling  a  physician  in  such  cases, 
and  following  his  directions ;   and  also  to  explain  the  reasons  for 
these  directions  in  such  a  way  that  they  can  be  intelligently  fol- 
lowed.    It  is  far  easier  to  avoid  an  evil  if  we  understand  its  causes, 
the   possibility  of  its  occurrence,   and   the   methods   to   be  em- 
ployed in  its  avoidance.     For  these  reasons  I  am  including  a  brief 
description  of  each  disease  discussed,  the  treatment  usually  em- 
ployed, and  the  complications  which  may  arise  during  its  course. 
In  some  cases,  especially  in  so-called  children's  diseases,  what 
seems  to  be  a  trifling  matter  may  have  very  serious  consequences. 
Measles.     Measles  is  a  much  more  serious  disease  than  most 
persons  consider   it  to  be.     Not    only  is    it  often    followed  by 
serious  complications,   but  the  percentage  of  deaths  from  this 
disease,  particularly  among  children  under  six  years  of  age,  is 
quite  large.     Therefore  the  patient  should  be  carefully  watched 
and    guarded    against    complications.     Ear    troubles,    enlarged 
tonsils  and  adenoids,  bronchitis  and  pneumonia,  Bright's  disease, 
occasionally  heart  trouble,  arthritis  (inflammation  of  the  joints), 
paralysis,  meningitis,  dysentery,  and  brain  abscesses  are  all  com- 
plications of  measles.     The  eyes  are  affected  greatly,  and  should 
be  guarded  from  the  light  during  the  course  of  -the  disease ;   and 
all  reading  should  be  forbidden  until  convalescence  is  well  ad- 
vanced.    Tuberculosis  also  may  follow  measles ;    and  because  of 
the  weakening  effect  that  measles  has  upon  the  respiratory  organs, 
the  patient  should  be  watched  carefully  for  some  months  after  he 
is  apparently  well. 

A  case  of  measles  is  infectious  during  its  whole  course,  and  is 
acutely  so  in  the  early  stages  before  the  disease  is  generally  recog- 
nized. The  germs  are  found  in  the  secretions  of  the  mouth,  throat, 

143 


144          Personal  Hygiene  and  Home  Nursing 

and  eyes.  The  patient  should  be  kept  in  bed,  the  room  should 
be  well  ventilated  and  cool,  and  great  care  should  be  taken  to 
guard  against  exposure  and  chilling.  The  incubation  period  of 
measles  is  about  eight  or  nine  days.  The  first  symptoms  resemble 
a  cold,  and  the  rash  appears  about  four  days  later.  Practically 
every  one  who  has  not  had  the  disease  contracts  it  on  exposure, 
and  to  prevent  infection  it  is  necessary  to  isolate,  before  the  symp- 
toms actually  appear,  any  one  who  is  developing  the  disease. 

German  measles.  German  measles  resembles  both  measles 
and  scarlet  fever.  The  rash  is  like  that  of  measles,  and  the  throat 
symptoms  are  like  those  of  scarlet  fever.  It  is  a  mild  but  highly 
infectious  disease.  There  are  seldom  complications  if  ordinary 
care  is  taken. 

Mumps.  At  first  mumps  may  be  mistaken  for  grippe.  Early 
symptoms  are  usually  fever  and  headache.  The  first  symptom 
may  be  a  sharp  pain  in  the  jaw  when  something  sour  has  been 
eaten.  In- mumps,  the  gland  in  front  of  and  below  the  ear  (the 
parotid  gland)  is  swelled,  and  when  the  pain  and  swelling  both 
appear  there  can  be  no  further  doubt  of  the  diagnosis.  The  in- 
cubation period  is  from  two  to  three  weeks.  The  patient  is  con- 
sidered dangerous  to  others  for  about  four  weeks  from  the 
enlargement  of  the  glands. 

The  patient  should  be  kept  in  bed  until  the  temperature  is 
normal.  Hot  and  cold  compresses  may  be  applied  to  the  swelling, 
and  cold  baths  given  to  decrease  the  fever.  Children  are  not 
very  ill,  as  a  rule,  but  with  adults  the  disease  is  often  more  serious. 
In  either  case,  care  should  be  taken  to  prevent  complications. 

Whooping  cough.  In  cases  of  whooping  cough  in  young  infants 
it  is  necessary  to  guard  against  choking.  During  a  severe  paroxysm 
of  coughing  a  direct  current  of  fresh  air  in  the  face  will  often  give 
relief.  Children  suffering  from  this  disease  should  be  kept  out  of 
doors  except  in  damp  weather,  and  should  be  kept  absolutely 
away  from  other  children.  The  clothes  should  be  changed 
frequently  and  special  attention  given  to  cleanliness,  as  the 


Some  Common  Communicable  Diseases          145 

matter  coughed  up  or  vomited  is  full  of  the  germs.  Whenever 
possible  in  such  diseases,  the  infected  matter  should  be  de- 
posited on  cloths  that  can  be  burned,  or  in  pans.  Bathing 
should  be  done  carefully,  and  the  child  should  be  kept  out 
of  draughts  and  not  allowed  to  become  fatigued.  Pneumonia 
sometimes  comes  on  during  an  attack  of  this  disease  or  during 
convalescence  from  it. 

While  the  paroxysms  of  coughing  are  severe,  it  is  best  to  keep 
the  child  in  bed.  If  vomiting  is  persistent  and  occurs  soon  after 
food  has  been  taken,  the  nourishment  should  be  repeated  after 
fifteen  or  twenty  minutes.  Otherwise  the  child  may  be  weakened 
by  lack  of  food.  Water  should  be  given  freely.  A  close-fitting 
abdominal  band  is  of  great  assistance  to  the  patient.  It  supports 
the  abdominal  muscles  during  a  fit  of  coughing  and  lessens  the 
danger  of  hernia,  which  is  the  protrusion  of  a  loop  of  the  intestine 
through  a  rupture  in  the  abdominal  wall  beneath  the  skin. 

Isolation  should  be  continued  for  at  least  five  weeks,  or  until 
the  constant  whooping  has  ceased.  A  slight  cough  may  continue 
for  months,  and  there  may  be  a  tendency  to  "whoop"  dur- 
ing a  coughing  or  crying  spell.  In  some  places  whooping  cough 
is  being  treated  successfully  by  inoculation,  and  in  severe  cases 
this  treatment  should  be  tried.  The  incubation  period  is  usually 
from  one  to  three  weeks. 

Scarlet  fever.  In  scarlet  fever  any  discharge  from  the  ears, 
seeming  deafness,  or  complaint  of  pain  in  the  ears  should  be  re- 
ported at  once  to  the  physician.  In  this  and  other  infectious  dis- 
eases the  patient  should  be  guarded  against  sudden  movements, 
as  sitting  or  standing  up  suddenly,  because  the  heart  is  much 
weakened  and  an  attack  of  heart  failure  is  possible.  The  urine 
should  also  be  measured  and  its  character  reported  to  the  physician, 
as  any  complication  affecting  the  kidneys  may  result  in  Bright's 
disease.  This  care  should  continue  until  well  into  convalescence. 
Nervousness  and  chorea  are  also  complications  to  guard  against 
in  children  suffering  from  scarlet  fever. 


146          Personal  Hygiene  and  Home  Nursing 

A  child  who  has  scarlet  fever  should  be  carefully  protected 
against  a  sudden  chill,  and  kept  in  bed  in  a  cool,  airy  room.  The 
bowels  should  move  regularly,  and  the  patient  should  be  kept  on  a 
liquid  diet  and  encouraged  to  drink  water  freely.  Cool  sponge 
baths  may  be  given  when  the  fever  is  high  or  when  there  is  delirium. 

Diphtheria.  Complications  of  diphtheria  are  heart  failure, 
infection  in  the  mastoid  sinus,,  albumin  in  the  urine,  paralysis  in 
various  parts  of  the  body,  and  acute  diarrhea.  Diphtheria  now- 
adays is  not  the  dreaded  epidemic  disease  of  fifteen  or  twenty 
years  ago.  With  the  use  of  antitoxin  the  after  effects  are  far  less 
serious  than  formerly,  and  the  death  rate  of  those  attacked  has 
fallen  from  45  per  cent  to  10  per  cent. 

Antitoxin  itself  in  all  ordinary  cases  does  practically  no  harm 
to  the  patient.  Sometimes  a  little  rash  will  appear  on  the  body, 
near  the  point  where  the  serum  is  injected,  or  temporary  pain  in 
the  joints  may  follow  its  use ;  but  these  disadvantages  are  trifling 
in  comparison  with  the  beneficial  effects  of  the  serum.  Diphtheria 
antitoxin,  as  well  as  other  serums  and  vaccines,  is  manufactured 
under  government  control,  and  each  lot  is  thoroughly  tested  before 
being  used  on  human  beings.  They  should  be  carefully  admin- 
istered to  prevent  infection  from  other  sources,  and  given,  of  course, 
by  a  physician  who  understands  their  use.  The  size  of  the  dose 
depends  upon  the  seriousness  of  the  disease.  Large  doses  can 
be  given  without  injury.  The  first  dose  of  antitoxin  given  in  an 
ordinary  case  of  the  disease  is  usually  6000  units,  and  this  is  re- 
peated as  often  as  necessary.  In  a  serious  case  as  much  as  16,000 
units  is  given  at  once,  and  as  much  as  100,000  units  during  the  day 
is  sometimes  given  to  children.  Antitoxin  should,  if  needed,  be 
given  to  the  nurse  also  and  to  others  who  have  come  into  close 
contact  with  the  patient,  as  it  will  prevent  the  development  of  the 
disease  in  them  (page  141).  The  diphtheria  antitoxin  does  not, 
like  the  vaccine  of  smallpox,  give  immunity  for  years  against  the 
disease,  but  affords  temporary  help  to  the  body  by  neutralizing 
the  toxin  produced  by  the  germs. 


Some  Common  Communicable  Diseases         147 

Diphtheria  is  one  of  the  diseases  frequently  spread  by  healthy 
carriers.  These  may  be  persons  who,  after  recovering  from  the 
disease,  still  have  active  germs  in  their  throat  and  nose;  or  they 
may  be  those  who,  having  come  in  contact  with  some  one  having 
diphtheria,  do  not  themselves  develop  the  disease  but  yet  are 
carriers  of  virulent  germs.  When  a  case  of  diphtheria  is  found 
in  a  school  or  home,  cultures  should  be  made  from  the  throats  of 
all  who  have  come  in  contact  with  the  patient,  and  all  carriers 
of  the  germs  should  be  isolated  until  the  danger  of  conveying  the 
disease  is  over.  Recently  it  has  been  found  that  sores  in  the 
skin  may  be  caused  by  the  diphtheria  bacillus,  and  that  the  germs 
may  be  spread  from  these  sores  as  well  as  from  the  throat. 
Usually  the  incubation  period  is.  from  one  to  three  days,  but  it 
may  be  from  a  few  hours  to  ten  days  or  even  more.  The  patient 
should  be  kept  in  quarantine  until  cultures  show  that  the  throat 
is  free  from  germs. 

Chicken  pox.  Chicken  pox  is  highly  infectious.  The  first 
symptoms  are  usually  a  chill,  vomiting,  and  pain  in  the  back. 
The  rash  in  its  early  stages  does  not  resemble  that  of  smallpox, 
but  at  a  later  stage  of  the  disease  has  much  the  same  appearance 
as  that  of  the  early  stages  of  smallpox.  As  a  rule  the  disease  is 
mild  in  children,  but  may  sometimes  be  quite  severe  in  adults. 
There  are  seldom  complications,  although  cases  of  nephritis  (in- 
flammation of  the  kidneys)  and  paralysis  have  been  reported. 
Unless  the  pustules  are  rubbed  or  scratched  or  unless  they  are 
unusually  large,  there  are  no  scars. 

Smallpox.  Smallpox  patients  are  almost  always  removed  to  a 
hospital,  so  that  this  disease  is  very  rarely  nursed  in  the  home. 
It  is  an  acute  fever,  highly  infectious.  The  first  symptoms  are 
intense  headache,  pain  in  the  back  and  limbs,  and  vomiting. 
When  the  rash  first  appears  it  resembles  that  of  scarlet  fever, 
but  in  four  days  it  changes  to  the  characteristic  rash  with  the 
peculiar  odor  of  smallpox. 

The  treatment  is  that  given  to  most  fever  patients,  and  the 


148          Personal  Hygiene  and  Home  Nursing 

IMPORTANT  FACTS  IN  REGARD  TO 


DISEASE 

INCUBATION  PERIOD 

RASH 
APPEARS 

CHARACTER  OF  RASH 

Typhoid  fever 

Usual  :  about  2 
weeks.  Extreme  : 
5  to  23  days 

7th  to 
loth  day 

Red,  elevated;  disappears  under 
pressure.  Usually  found  on 
abdomen 

Measles 

8  to  12  days 

3d  to  5th 
day 

Small  red  spots,  like  fleabites. 
First  on  forehead,  face,  back 
of  neck,  and  other  uncovered 
parts 

Rubella  or 
German 
measles 

Usual  :  about  2 
weeks.  Extreme  : 
IO  to  24  days 

1st  to 
3d  day 

Resembles  either  measles  or 
scarlet  fever;  comes  first  on 
face 

Chicken  pox 

4  to  14  days 

•2d  day 

Small  red  vesicles,  first  on  un- 
covered parts  of  the  body 

Smallpox 

Usual:  12  to  14 
days.  Extreme  : 
10  to  21  days 

3d  day 

First  on  forehead  and  face, 
wrists,  and  palms  of  hands 

Scarlet  fever 

Usual  :  2  to  4  days. 
Extreme  :  few 
hours  to  3  weeks 

2d  day 

Bright  red  pin  point,  first  on 
chest  and  upper  extremity 

patient  is  kept  in  bed,  on  a  liquid  diet,  with  cool  baths,  the  affected 
parts  covered  with  lint  wet  in  an  ice-cold,  mild  disinfectant  solu- 
tion. When  crusts  form  over  the  rash,  they  are  softened  with 
vaselin.  Care  should  be  taken  to  prevent  rubbing  or  scratching 
of  the  scabs,  as  this  increases  the  danger  of  scars.  The  eyes  must 
be  washed  with  boric  acid  solution. 

Vaccination.  Smallpox  is  not  now  the  virulent  disease  it  used 
to  be.  Most  cases  are  mild,  and  the  percentage  of  deaths  is  low. 
Before  vaccination  was  discovered,  about  95  per  cent  of  the  popu- 
lation suffered  from  smallpox  and  at  least  35  per  cent  of  those 
attacked  died  of  the  disease. 


Some  Common  Communicable  Diseases 

CERTAIN   COMMUNICABLE  DISEASES 


149 


RASH  FADES 

DURATION 
OF  DISEASE 

PATIENT  DANGEROUS  TO  OTHERS 

IMMUNITY  CONFERRED 

2d  or  3d  day. 
Successive 
crops  to  3d 
week 

14  to  34 

days 

8  weeks  from  first  symptoms; 
may  become  permanent  germ 
carrier 

Second      attack 
known  to  occur 

7th  day 

3  weeks 

3  weeks  from  rash,  if  cough  has 
ceased 

Usually,    but    occa- 
sional second  at- 
tack 

1st  to  4th  day 

I  week 

3  weeks  from  eruption 

Yes 

Comes  and 
goes.  First 
crop  fol- 
lowed by 
others 

6  to  7 
days 

Until  scabs  are  gone 

Yes 

9th  day  scabs 
fall 

14  to  21 
days 

Until  scabs  are  gone 

ad  attacks  known 

3d  to  yth  day 

3  to  8 
weeks 

Average  time  about  6  weeks 
from  appearance  of  rash.  In- 
fectious until  throat,  eyes,  and 
ears  are  healed 

2d  attacks  rare 

The  germs  of  smallpox  are  long-lived,  and  have  been  known 
to  exist  for  months  in  clothing,  books,  letters,  and  other  things. 
They  are  carried  by  flies,  and  may  be  borne  in  the  air  for  a  short 
distance.  The  fact  that  one  is  in  good  physical  health  does  not 
protect  against  the  germ  of  smallpox.  There  are  only  two  ways 
to  become  immune:  one  is  to  have  the  disease,  even  in  a  mild 
form ;  the  other  is  to  be  vaccinated.  Those  who  have  been  vacci- 
nated either  do  not  contract  the  disease  or  have  mild  attacks. 
The  only  deaths  that  occur  from  smallpox  are,  practically  without 
exception,  among  those  who  have  not  been  vaccinated  at  all,  or 
not  for  many  years.  During  an  epidemic  in  Philadelphia  in  1903- 


150          Personal  Hygiene  and  Home  Nursing 

1904,  not  one  person  who  took  the  disease  had  been  vaccinated 
within  five  years.  In  England,  in  one  county  where  vaccination 
was  not  practiced,  the  epidemic  continued  for  months  in  spite  of 
all  means  of  disinfecting  and  medical  treatment,  and  was  not 
stamped  out  until  vaccination  was  used.  Concerning  an  epidemic 
in  Porto  Rico  in  1916,  similar  facts  are  recorded,  vaccination  not 
having  been  enforced  there  because  of  lack  of  funds.  At  least 
4000  children  in  the  schools  of  San  Juan  had  been  vaccinated,  and 
not  one  case  occurred  among  them ;  but  more  than  500  cases 
occurred  among  the  adults  in  San  Juan  and  the  surrounding  coun- 
try. Upon  the  appearance  of  the  disease,  money  was  appropriated 
by  the  government,  vaccination  was  made  compulsory,  and  vac- 
cinators  were  appointed.  Those  suffering  from  the  disease  were 
taken  to  hospitals,  their  homes  were  disinfected,  and  the  disease 
was  soon  stamped  out.  At  first,  through  accident  or  intention, 
some  persons  were  not  at  home  at  the  time  of  the  visits  of  the 
doctors,  and  the  severe  cases  and  deaths  which  occurred  were 
practically  all  among  these  persons. 

Vaccination  will  give  immunity,  ordinarily,  for  from  five  to  nine 
years.  The  exact  period  varies  with  the  individual.  A  safe  rule 
to  follow  is  that  of  being  vaccinated  once  in  seven  years,  or  of tener 
if  there  is  an  epidemic  or  if  one  has  been  exposed  to  the  disease. 

Infantile  paralysis  or  poliomyelitis.  Children  under  five  years 
of  age  are  most  often  attacked  by  infantile  paralysis,  but  older 
children  and  even  adults  are  not  immune.  The  germ  attacks 
the  spinal  cord  and  brain,  and  is  found  in  the  secretions  of  the 
mouth  and  nose,  and  in  the  evacuations  from  the.  bowels.  The 
disease  is  a  communicable  one,  and  although  the  methods  of  con- 
trolling it  are  not  well  worked  out,  it  is  probable  that  healthy 
carriers  of  the  germs  are  chiefly  responsible  for  its  spread.  The 
infectious  material  may  be  transferred  by  contact  with  another 
case  or  with  a  carrier  and  doubtless  upon  soiled  utensils,  hand- 
kerchiefs and  towels,  or  by  flies.  Among  the  lower  animals  only 
monkeys  can  be  given  the  disease.  It  is  not  believed  that  dogs,  cats, 


Some  Common  Communicable  Diseases         151 

mice,  insects,  dust,  or  water  have  anything  to  do  with  its  spread. 
The  following  are  the  directions  and  regulations  of  the  board  of 
health  of  the  state  of  New  York  for  the  control  of  this  disease : 

When  poliomyelitis  is  prevailing,  if  any  of  the  symptoms  above  de- 
scribed appear  in  a  person  of  your  household,  isolate  the  patient  and 
summon  a  physician  immediately. 

When  no  physician  is  in  attendance,  the  head  of  the  household  is 
required  to  report  at  once  to  the  health  officer  any  case  of  communicable 
disease  occurring  in  the  household. 

Protect  your  family  by  sending  the  patient  to  a  hospital,  if  the  family 
physician  approves  of  this  course.  If  the  patient  must  be  isolated  at 
home,  provide  a  nurse  if  possible. 

If  the  patient  has  just  attended  school  or  Sunday  school,  advise  the 
health  officer  immediately. 

The  proper  disposal  of  the  discharges  from  the  nose,  throat,  and 
bowels,  not  only  of  the  patient  but  of  all  in  isolation,  is  of  the  greatest 
importance  in  preventing  the  spread  of  the  disease.  Secure  detailed 
instructions  from  your  physician  or  the  health  officer. 

Physicians  and  health  officers  are  required  by  law  to  perform  certain 
duties.  In  the  interest  of  public  health,  parents  should  give  their  as- 
sistance and  not  cherish  ill  feelings  against  them  on  account  of  incon- 
venience and  discomfort  which  may  be  caused  by  quarantine  measures. 


The  infectious  agent  is  said  to  be  readily  destroyed  by  menthol, 
bichlorid  of  mercury,  and  a  two  per  cent  solution  of  hydrogen  peroxid, 
A  temperature  of  45-50°  C.  (113-122°  F.)  for  one-half  hour  will  kill 
the  organism.  Carbolic  acid  is  relatively  ineffective. 


In  the  presence  of  an  outbreak  of  poliomyelitis,  a  search  for,  and  a 
careful  examination  of,  ill  children  should  be  made.  All  children  having 
fever  should  be  isolated  pending  the  diagnosis. 

A  placard  must  be  posted  on  the  house,  apartment,  or  room  occupied 
by  a  patient,  stating  the  existence  therein  of  a  communicable  disease. 

The  patient  must  be  isolated  for  a  period  of  at  least  three  weeks 


152          Personal  Hygiene  and  Home  Nursing 

and  those  in  contact  with  the  patient  for  two  weeks  from  date  upon  which 
they  last  saw  the  patient. 

After  isolation  by  the  health  officer,  no  patient  shall  be  removed  from 
or  to  any  place  without  permission  from  the  health  officer.  A  case 
must  not  be  removed  to  another  municipality  without  permission  from 
the  health  officer  thereof. 

In  the  presence  of  an  outbreak  of  several  cases,  it  may  be  necessary 
to  prohibit  attendance  at  public  gatherings.  Require  special  care  in  the 
cleaning  of  glasses  and  other  utensils  used  by  the  public  at  soda-water 
fountains,  picnic  grounds,  and  elsewhere.  The  use  of  individual  drink- 
ing cups  should  be  urged. 

In  the  presence  of  an  outbreak,  it  is  highly  important  that  so  far  as 
possible  all  milk  used  by  children  should  be  pasteurized.  Milk  bottles 
or  other  containers  should  not  be  left  at  a  house  where  a  case  of  polio- 
myelitis exists. 

Household  pets  should  be  excluded  from  the  room  occupied  by  a 
patient,  and  flies  should  be  excluded  by  effective  screening. 

When  proper  isolation  and  satisfactory  care  for  the  patient  cannot 
be  secured  in  a  home,  the  Department  recommends  that  the  patient  be 
removed  to  an  isolation  hospital.  However,  it  is  to  be  noted  that  during 
the  early  stage  of  the  disease  the  patient  needs  complete  rest  in  bed, 
and  transfer  to  a  hospital,  if  not  conducted  with  regard  for  the  condition 
of  the  patient,  may  do  harm. 

Sick-room  precautions  should  include  attention  to  cleaning  and  dis- 
infection of  eating  utensils,  personal  and  bed  clothing,  rugs,  door  knobs, 
and  other  things  handled  by  the  patient  or  attendant.  The  health 
officer  should  see  that  all  necessary  instructions  are  given  to  householders, 
nurses,  and  attendants. 

At  the  termination  of  quarantine,  the  body  and  hair  of  the  patient 
and  of  those  who  have  been  in  contact  with  him  should  be  thoroughly 
washed  with  soap  and  water,  and  the  room  or  rooms  thoroughly  cleansed 
with  soap  and  hot  water,  aired  and  sunned. 

Symptoms  of  poliomyelitis.  This  disease,  like  many  others, 
begins  like  a  cold,  which  is  another  reason  for  the  prompt  isola- 
tion of  patients  with  colds.  The  incubation  period  is  from  two  to 
fourteen  days,  and  some  of  the  following  symptoms  may  be  present 


Some  Common  Communicable  Diseases         153 

before  there  are  any  signs  of  paralysis:  an  apparent  cold  in  the 
head,  weakness,  fever,  perhaps  diarrhea  or  other  digestive  dis- 
turbances, pain,  especially  along  the  spine,  stiff  neck,  and  some- 
times convulsions.  There  may  be  early  paralysis  of  a  part  of  the 
body,  or  the  paralysis  may  not  appear  until  convalescence. 

Use  of  serum.  During  the  epidemic  of  infantile  paralysis  in 
New  York  in  1916,  and  before  that  date  in  France,  blood  serum 
drawn  from  convalescents  was  injected  into  others  suffering  from 
the  disease.  The  results  of  this  treatment  were  promising,  but 
the  fluid  is  hard  to  obtain  and  the  treatment  seldom  given. 

Treatment  of  paralyzed  muscles.  Many  cases  where  paralysis 
appears  make  a  complete  recovery.  In  some  instances  the  paral- 
ysis disappears  rapidly ;  in  others  weeks  and  months  are  required 
for  recovery.  Frequently  the  cells  of  the  motor  nerves  in  the 
spinal  cord  are  injured  but  not  destroyed.  If  the  cells  are  de- 
stroyed, there  is  no  hope  of  restoring  power  to  the  muscles ;  but 
if  they  are  merely  injured,  it  is  possible  to  restore  the  muscles  to 
partial  if  not  complete  use  by  proper  orthopedic  treatment.  As 
the  process  of  the  recovery  of  the  muscles  may  extend  over  months 
and  years,  the  treatment  should  be  continued  indefinitely.  Muscles 
apparently  completely  paralyzed  have  recovered  at  least  partial 
use  after  years  of  apparent  uselessness.  I  have  treated  children 
who  had  been  at  least  three  years  without  treatment,  whose  muscles 
were  wasted  and  apparently  lifeless,  and  who  were  unable  to  walk ; 
and  after  treatment  I  have  seen  them  walking  and  able  to  use 
muscles  which  they  had  not  been  able  to  use  since  their  paralysis. 

The  treatment  used  is  massage,  electricity,  and  active  exercise. 
The  type  of  exercise  used  is  known  as  "  educational  " ;  in  this 
the  patient  is  taught  the  object  of  the  exercise  and  is  encouraged 
to  make  an  effort  to  contract  the  muscles  affected.  In  some 
clinics  the  child's  attention  is  drawn  to  the  muscles  by  pricking 
them  with  a  sharp-pointed  stick  or  pencil ;  but  I  have  found  this 
unnecessary,  for  children  even  two  and  a  half  to  three  years  old 
can  be  made  to  understand  what  is  wanted,  and  after  being  taught 


154          Personal  Hygiene  and  Home  Nursing 

to  observe  the  movement  in  one  leg,  will  make  an  effort  to  move 
the  other  in  the  same  way.  Older  children,  as  young  as  five  or 
six  years  of  age,  were  shown  muscle  charts  and  made  to  understand 
something  of  the  position  and  working  of  the  muscles.  Almost 
without  exception  they  were  interested,  even  asking  the  name  of 
a  particular  muscle  and  trying  hard  to  make  it  do  its  work. 
If  there  is  extreme  weakness  or  no  apparent  life  in  the  muscle, 
the  child  should  be  taught  to  make  the  effort  while  the  nurse  makes 
the  movement  and  so  exercises  the  muscle.  The  treatment 
should  not  be  abandoned  even  though  there  seems  little  im- 
provement, for  as  long  as  there  is  life  in  the  muscle,  exercise  will 
strengthen  it.  At  first  ten  to  twenty  minutes  once  or  twice 
daily  is  long  enough  for  a  treatment,  including  massage  and 
exercises.  As  the  child  and  the  muscle  become  stronger,  the 
time  may  be  extended  to  forty  or  to  sixty  minutes,  according  to 
the  age  of  the  child  and  the  number  of  muscles  involved.  The 
muscles  work  best  if  warm,  therefore  heat  should  be  applied 
before  giving  the  exercises.  This  may  be  done  by  hot  compresses, 
a  hot  bath,  or  one  of  the  appliances  made  for  this  purpose. 

Braces.  Every  paralyzed  child  should  be  under  the  care  of  an 
orthopedic  surgeon,  and  no  braces  should  be  put  on  him  unless 
ordered  by  the  surgeon.  Braces  are  useful  in  preventing  the 
deformities  which  frequently  follow  paralysis,  but  they  must  be 
exactly  right  to  be  of  service,  and  as  the  child  grows  they  must 
be  changed.  They  should  not  be  too  heavy,  and  they  should  not, 
more  than  is  absolutely  necessary,  interfere  with  the  use  of  the 
paralyzed  muscle.  The  instrument  maker  understands  the 
mechanism  of  the  braces,  but  not  of  the  human  body.  The  good 
orthopedic  surgeon  understands  both,  and  whatever  braces  are 
worn  should  be  selected  by  his  advice. 

A  brace  is  worn  to  prevent  deformity  by  holding  the  body 
straight,  but  it  retards  the  growth  of  the  muscles  more  than  it 
aids  it,  and  if  a  brace  is  used  there  is  all  the  more  reason  for  regular 
massage  and  exercise. 


CHAPTER   TWENTY-ONE 

TUBERCULOSIS 

THE  subject  of  tuberculosis  has  been  much  discussed  during 
the  past  few  years,  and  for  many  generations  the  disease  has  been 
one  of  the  most  dreaded  of  all  that  exist.  Until  comparatively 
recent  times  it  was  believed  incurable,  in  spite  of  the  fact  that  many 
cases  in  which  a  person  "  given  up  by  all  the  doctors  and  told  that 
he  had  less  than  a  year  to  live  "  went  on  living  to  an  active  and 
cheerful  old  age.  There  is  still  much  ignorance  on  the  subject, 
and  many  cases  end  in  death  when  proper  knowledge  and  care 
on  the  part  of  the  patient  would  have  resulted  in  cure.  Many, 
perhaps  most,  cases  of  tuberculosis  are  curable  if  taken  in 
time.  If,  however,  the  patient,  not  realizing  the  cause  of  his  ill 
health  and  neglecting  to  have  himself  examined,  allows  his  health 
to  run  down  before  beginning  any  treatment,  he  may  have  a  hard 
fight  to  build  himself  up  again.  Some,  when  told  that  they  have 
symptoms  of  tuberculosis,  become  so  terror  stricken  that  they 
give  up  the  fight  at  once.  Others  refuse  to  believe  that  they  have 
anything  serious  the  matter  with  them  and  decline  to  take  pre- 
cautions. It  is  important,  therefore,  to  understand  the  condi- 
tions and  causes  of  tuberculosis  in  order  to  appreciate  the  im- 
portance of  taking  a  case  of  the  disease  in  time  to  effect  a  cure. 

Tuberculosis  not  inheritable.  The  germ  of  this  disease  was 
discovered  by  Koch  in  1882.  Up  to  that  time,  and  for  some  years 
after,  it  was  believed  to  be  an  inherited  disease.  Children  of 
consumptive  parents  were  expected  to  have  the  disease  and  die 
of  it,  and  in  many  cases  they  did.  It  is  now  understood  that  the 
inherited  tendency  consists  of  a  low  power  of  resistance  to  the 
disease;  that  tuberculosis  is  contracted,  not  by  inheritance,  but 
from  the  exposure  of  infants  and  young  children  to  the  germs; 
and  that  the  prevalence  of  tuberculosis  among  the  children  of 
tubercular  parents  has  been  largely  due  to  the  fact  that  it  is  a 
communicable  disease  and  that  in  such  families  no  effort  had  been 
made  to  stop  the  spread  of  the  contagion.  Also,  because  it  was 


156          Personal  Hygiene  and  Home  Nursing 

expected  that  members  of  such  families  would  have  the  disease 
and  would  die  of  it,  practically  no  fight  had  been  made. 

In  numerous  cases,  also,  the  so-called  consumptive  families 
were  found  among  the  poor  working  class,  compelled  to  live  in 
insanitary  conditions,  with  insufficient  light,  air,  and  food ;  and 
these  people  had  little  time  or  money  to  spend  in  attempts  to  cure 
a  disease  which  they  believed  incurable.  They  developed  a  sort 
of  fatalism  in  thought,  believing  that  if  it  was  their  destiny  to  die 
of  consumption  at  twenty,  thirty,  or  an  earlier  age,  they  would  die 
of  it  and  could  not  escape  their  doom. 

Today  the  disease  is  so  much  better  understood,  the  means 
used  to  cure  it  are  so  sensible  and  simple,  and  so  many  cures  are 
made  in  the  early  stages,  that.no  one  should  give  up  hope. 

The  tuberculosis  germ.  There  are  four  varieties  of  the  tuber- 
culosis germ,  two  of  which  infect  man.  One  of  these  is  known  as 
the  human  type,  the  other  as  the  cattle  or  bovine  type.  The  human 
type  is  derived  from  the  sputum  of  human  beings  who  have  the 
disease,  and  these  germs  are  thrown  out  of  the  mouth  and  nose 
in  talking,  laughing,  sneezing,  or  spitting.  Other  persons  draw 
these  germs  into  the  nose  and  mouth  by  breathing  in  dried  sputum 
or  the  droplets  or  spray  in  which  they  are  borne,  or  the  germs  may 
be  carried  into  the  mouth  by  hands  which  have  come  in  contact 
with  the  hands  of  the  patient  or  with  something  infected,  such  as 
dishes,  a  pencil,  clothing,  flowers,  or  public  towels  or  drinking  cups. 
Infected  milk,  food,  or  water  also  will  convey  the  disease. 

After  entering  the  mouth,  some  of  the  germs  may  infect  the 
tonsils,  others  are  swallowed  in  the  saliva  or  in  food  and  are  carried 
into  the  stomach.  Many  of  them  are  killed  by  the  acid  in  the 
gastric  juice,  but  others  pass  into  the  intestine  and  are  absorbed 
into  the  blood.  In  the  blood  they  are  carried  through  the  body, 
and  settle  in  whatever  part  is  favorable  to  their  development. 
They  may  find  a  place  in  the  joints,  in  bones,  in  the  kidneys,  in 
the  lymph  nodes,  or  in  the  lungs. 

The  bovine  type  of  the  germ  does  not  often  affect  the  lungs 


Tuberculosis  157 

of  human  beings,  but  attacks  the  joints,  bones,  and  the  nodes  of 
the  lymphatic  system.  It  is  carried  into  the  human  body  by  raw 
milk,  but  can  be  killed  in  milk  through  pasteurization.  It  is 
often  found  in  butter,  where  it  will  live  for  weeks.  The  danger  of 
contracting  tuberculosis  from  eating  the  flesh  of  infected  cattle 
is  small,  for  the  germs  are  killed  in  cooking.  In  many  states  a 
strict  examination  of  dairy  cattle  is  made,  and  cows  proved  to 
have  the  disease  are  killed. 

In  open  air  and  sunshine,  tuberculosis  germs  quickly  die,  but 
in  damp,  dark  places  they  will  live  for  weeks  and  months.  Be- 
fore moving  into  a  house  or  apartment  one  should  make  sure  that 
no  one  living  there  recently  has  had  the  disease.  In  any  case  the 
floors  and  walls  should  be  thoroughly  cleaned.  If  a  consump- 
tive is  known  to  have  lived  in  the  house,  it  should  be  disinfected, 
repainted,  and  papered  throughout. 

Checking  the  spread  of  tuberculosis.  If  all  the  tuberculosis 
germs  could  be  killed  at  their  source,  there  would  soon  be  no  more 
consumption  in  the  world.  A  person  having  the  disease  should 
take  every  possible  precaution  to  keep  it  from  infecting  others. 
The  members  of  the  family,  and  even  the  physician,  often  feel  so 
unwilling  to  tell  the  patient  that  he  has  tuberculosis,  for  fear  of 
the  mental  effect,  that  the  germs  are  spread  not  only  among  the 
family  but  among  others.  In  most  states  the  law  requires  a  re- 
port on  such  cases,  and  it  is  not  only  a  violation  of  the  law,  but 
unkind  to  the  patient,  to  fail  to  make  this  report.  When  the 
public  really  understands  the  possibility  of  a  cure  in  the  early 
stages  of  the  disease,  it  will  be  seen  that  the  sooner  a  patient  is 
told  of  his  condition  and  begins  to  carry  out  the  doctor's  orders, 
the  better  chance  there  will  be  of  recovery.  Most  persons,  if 
told  the  truth  in  regard  to  the  importance  of  doing  so,  will  be  quite 
willing  to  take  the  precautions  necessary  to  protect  others. 

As  the  germs  are  contained  in  the  sputum,  this  should  be  re- 
ceived either  in  vessels  containing  a  disinfectant  or  in  paper  cups 
or  bags  that  can  be  burned  immediately.  A  consumptive  should 


158          Personal  Hygiene  and  Home  Nursing 

not  kiss  any  one,  should  sleep  alone,  should  make  sure  that  his 
dishes  are  disinfected  before  being  used  by  others,  should  not 
expectorate  in  the  street  or  in  street  cars,  or  in  a  pocket  handker- 
chief, and  should  not  put  coins,  or  anything  likely  to  be  used  by 
any  one  else,  into  the  mouth. 

Treatment  of  tuberculosis  of  the  lungs.  The  measures  found 
efficacious  in  curing  tuberculosis  of  the  lungs  are  rest,  fresh  air, 
sunshine,  and  proper  food.  Medicine  has  no  effect,  except  as  it 
may  be  a  tonic  for  increasing  the  appetite,  or  as  it  may  help,  like 
cod-liver  oil,  in  building  up  the  tissue.  Valuable  time  is  often  lost 
by  taking  patent  medicines  which  claim  to  cure  but  have  no 
beneficial  effect  whatever.  Many  such  medicines  contain  drugs 
or  alcohol,  which  will  produce  a  temporary  mood  of  cheerfulness, 
but  have  an  ultimate  evil  effect.  When  the  disease  has  not  pro- 
gressed too  far,  complete  change  of  climate  is  always  best,  and 
even  where  it  has  progressed  considerably  this  may  have  a  good 
effect.  The  high  altitude  and  bracing  air  of  Colorado  and  the 
Northern  mountains  are  better  than  lower,  warmer  climates. 
The  debilitating  effect  of  a  Southern  climate  upon  the  general 
condition  of  the  patient  may  more  than  counterbalance  the  good 
effect  of  its  warmth. 

If  a  change  of  climate  is  impossible,  arrangements  can  be  made 
to  let  the  patient  sleep  out  of  doors.  .  Many  houses  have  a  balcony 
or  porch,  which  can  be  turned  into  a  sleeping  porch  by  putting  up 
awnings  or  Japanese  shades.  At  no  very  great  cost,  sleeping 
porches  or  sleeping  sheds  can  be  erected,  or  a  tent  placed  in  the 
yard.  I  have  known  persons  in  the  early  stages  of  the  disease  to 
recover,  by  sleeping  by  open  windows  and  paying  attention  to  their 
food  and  to  proper  rest. 

Many  medical  authorities  now  believe  that  light  is  very  help- 
ful in  the  treatment  of  tuberculosis.  In  giving  the  light  treatment 
a  large  part  of  the  body  is  exposed  to  the  sun  for  stated  periods. 
Too  long  exposure  to  intense  light  is  harmful ;  so  no  one  should 
attempt  to  give  himself  the  treatment  without  medical  advice. 


Tuberculosis  159 

Importance  of  rest.  A  consumptive  should  rest.  If  there  is 
fever,  the  patient  should  stay  in  bed.  It  is  not  desirable  that 
many  visitors  should  be  allowed,  and  complete  quiet  should  be 
maintained.  All  fatigue,  even  unnecessary  walking  about  the 
room,  should  be  avoided.  Coughing  is  frequently  the  result  of 
nervousness,  and  in  many  cases  it  can  be  controlled;  this  the 
patient  should  do  as  far  as  possible. 

Food  for  consumptives.  Eggs  and  milk  should  be  taken  in 
abundance.  The  more  fat  a  patient  eats  the  better,  and  meat 
also  should  be  eaten.  Tuberculosis  patients  have  usually  little 
appetite,  but  crave  a  variety  of  unwholesome  and  unattainable 
foods.  If  the  food  is  prepared  carefully  and  served  daintily  in 
as  great  variety  as  possible,  much  can  be  done  to  tempt  them 
to  eat.  It  is  possible  to  introduce  eggs  and  cream  into  many 
dishes  without  the  patient's  being  aware  that  the  increased  nourish- 
ment is  there.  An  egg  can  be  beaten  into  cream  sauce  or  a  lemon- 
ade ;  vegetables  can  be  served  with  cream ;  and  sometimes  an  egg 
poached  in  bouillon  with  or  without  a  spoonful  of  sherry  can  be 
relished  when  more  solid  food  would  be  refused.  Custards,  pud- 
dings, and  salad  dressings  also  admit  of  adding  beaten  eggs  to 
the  original  receipt  without  essential  change  in  the  flavor.  Season- 
ing has  a  great  deal  to  do  with  an  invalid's  relish  of  food,  and  the 
person  who  cooks  for  invalids  should  make  a  study  of  the  various 
seasonings  which  make  a  dish  savory  without  scorching  the  palate 
with  pepper  or  other  spice  in  excess. 

What  to  do  for  a  hemorrhage  from  the  lungs.  Few  emergencies 
are  as  alarming  as  the  sudden  appearance  of  blood.  It  is  at  such 
times  that  the  nurse  must  show  her  self-control  and  her  ability  to 
meet  an  unforeseen  occurrence.  If  not  in  bed  when  the  hemor- 
rhage occurs,  the  patient  should  be  put  to  bed,  made  to  lie  on  the 
side  of  the  body  on  which  the  lung  is  more  diseased,  and  kept  as 
quiet  as  possible.  The  patient  may  be  given  cracked  ice,  and  if  any 
soothing  medicine  for  the  prevention  of  coughing  has  been  prescribed 
by  the  doctor,  a  dose  of  this  may  be  administered.  Do  not  rouse 


160          Personal  Hygiene  and  Home  Nursing 


Dr.  A.  P.  Evans 

FIG.  58.  Radiograph  of  the  chest,  showing  tubercular  infection  of  the  lungs.  The 
small  dark  areas  are  tubercles,  which,  because  they  become  surrounded  with  calcium, 
cast  dark  shadows  on  the  photographic  plate.  The  dark  shadow  in  the  center  of  the 
photograph  is  the  heart. 

a  fainting  patient,  as  this  condition  is  a  natural  check  on  the  flow 
of  blood.  When  nursing  an  acute  case  of  tuberculosis,  it  is  well 


Tuberculosis 


161 


Dr.  A.  P.  Evans 

FIG.  59.    X-ray  picture  of  a  more  advanced  case  of  tuberculosis.    The  dark  areas 
(a  a)  in  the  upper  lobes  of  the  lungs  are  badly  infected. 

to  secure  from  the  doctor  exact  directions  for  this  particular  crisis. 

Advantages  of  early  diagnosis  and  treatment.    The  earlier  the 

diagnosis  is  made  and  treatment  begun,  the  greater  the  chance  of 


1 62          Personal  Hygiene  and  Home  Nursing 

recovery  and  the  less  danger  there  is  of  infecting  others.  The 
early  symptoms  of  tuberculosis  of  the  lungs  are  a  loss  of  weight, 
unusual  fatigue,  little  appetite  or  perhaps  indigestion,  a  slight  cough 
or  clearing  of  the  throat,  particularly  in  the  morning,  and  some- 
times expectoration.  If  the  temperature  is  taken,  it  is  found  to 
be  subnormal  (96.5°  to  98.4°  F.)  in  the  morning  and  above  99° 
in  the  evening.  There  may  be  a  feeling  of  chilliness  in  the  after- 
noon and  a  slight  sweat  at  night. 

Some  persons  may  recover  from  this  stage  without  special 
treatment;  but  many  patients  who  take  no  steps  to  check  the 
progress  of  the  disease  go  on  into  its  open  stage,  where  recovery  is 
much  more  difficult.  If  all  persons  who  find  themselves  suffer- 
ing with  any  or  all  of  these  symptoms  would  undergo  a  thorough 
examination  by  a  good  physician,  the  percentage  of  recoveries 
would  be  largely  increased.  Many  people,  either  because  they  do 
not  know  these  symptoms  or  because  they  refuse  to  recognize  them, 
neglect  themselves  or  attempt  to  treat  themselves  until  the  disease 
has  progressed  to  the  point  where  recovery  is  difficult  or  almost 
impossible,  and  until  by  their  lack  of  care  they  have  infected  those 
around  them. 

Hospitals  for  tuberculosis  patients.  Many  hospitals  exist  which 
are  given  up  entirely  to  the  treatment  of  tuberculosis.  Some  are 
expensive  to  the  patient,  but  others  are  supported  by  states, 
counties,  or  cities,  and  in  these  a  consumptive  has  little  or  no 
expense  to  bear.  The  advantages  of  entering  a  hospital  are 
several,  (i)  The  discipline  is  advantageous.  Too  often  mem- 
bers of  a  family  yield  too  much  to  the  patient  in  the  matter  of 
remaining  in  a  close,  hot  room  and  eating  improper  food.  (2)  The 
required  rest  and  quiet  and  freedom  from  interruption  are  secured 
in  a  hospital,  whereas  at  home  these  are  often  difficult  or  impos- 
sible to  obtain.  (3)  The  proper  food  is  supplied.  (4)  The  hos- 
pitals are  built  with  sleeping  porches  or  open  wards,  so  that  a 
patient  can  be  out  of  doors  day  and  night. 

It  often  happens  that  the  father  of  a  family  'feels  that  it  is 


Tuberculosis  163 

financially  impossible  for  him  to  give  up  his  work.  Even  in 
such  a  case  much  can  be  done  to  aid  in  the  fight  against  the  dis- 
ease. Societies  have  been  formed  in  various  cities  for  this  pur- 
pose, aiding  in  the  building  of  porches  and  giving  allowances  to 
help  the  families  of  laboring  men  so  that  they  may  stop  work  long 
enough  for  a  cure.  Many  hospitals  in  large  cities  have  con- 
nected with  them  social  workers  who  give  their  whole  time  to 
this  work.  One  of  the  largest  and  most  successful  of  these  organiza- 
tions is  in  connection  with  the  Massachusetts  General  Hospital 
in  Boston.  In  this  hospital  many  such  patients  are  treated  yearly. 
The  social  workers  go  into  the  homes  and  help  by  their  advice  and 
by  necessary  financial  aid  to  arrange  matters  for  the  patients. 
They  have  at  their  disposal  a  fund  for  building  porches  or  making 
other  arrangements  for  out-of-door  sleeping,  and  they  also  pro- 
vide milk,  eggs,  and  other  nourishing  food.  Patients  are  care- 
fully instructed  in  the  care  of  themselves.  They  receive  record 
sheets  upon  which  they  are  expected  each  day  to  put  down  the 
amount  of  food  taken,  the  amount  of  sleep  or  rest,  and  their 
various  symptoms.  Physicians  in  the  hospital  prescribe  the  whole 
life  of  the  patient,  even  to  the  number  of  visitors  allowed.  During 
the  patient's  confinement  in  bed  the  social  workers  make  visits 
to  the  home,  and  when  convalescent  the  patient  himself  reports 
to  the  hospital  at  stated  intervals,  bringing  the  charts.  After 
weighing  and  examining  him,  the  physicians  then  give  directions 
for  the  next  interval  between  reports.  Many  cures  have  been 
effected  in  this  way. 

Advanced  stages.  Even  in  late  stages  of  consumption  recovery 
is  sometimes  possible.  I  knew  one  case  of  a  girl  in  "  the  last  stages 
of  consumption  "  who  had  been  told  that  she  had  but  three  months 
to  live,  and  decided  to  go  to  Colorado.  No  one  believed  that  she 
would  live  to  get  there,  but  she  lived  for  twenty  years  thereafter. 
If  change  of  climate  is  made  at  the  first  appearance  of  the  disease, 
one  may  return  to  the  lower  altitude,  and  as  long  as  health  and 
strength  are  kept  up  there  will  be  no  return  of  the  sickness.  The 


164          Personal  Hygiene  and  Home  Nursing 

germ,  however,  may  remain  quiescent  in  the  lungs  for  years  and 
then  become  active ;  hence  a  healthful,  out-of-door  life,  with  good 
food,  must  be  the  rule. 

Much  may  be  done  by  determination  and  ingenuity.  In  one 
case  the  mother  of  several  little  children  was  told  that  she  had 
consumption,  but  the  physician  added,  "  Don't  look  so  frightened ; 
I  can  cure  you,  but  you  must  do  what  I  say."  The  regime  that 
he  prescribed  included  long  country  walks  and  fat-building  foods. 
The  young  woman  reduced  her  household  duties  to  the  lowest 
possible  number,  abandoning  absolutely  every  unnecessary  "  frill" 
in  her  scheme  of  living  in  order  to  have  the  time  and  strength  for 
out-of-door  life  and  the  money  for  needed  food  and  help;  and 
she  recovered. 

Many  years  ago,  long  before  the  importance  of  out-of-door  life 
in  cases  of  consumption  was  recognized,  a  clerk  dependent  on  a 
moderate  salary  for  his  existence  was  told  that  he  must  go  to 
Colorado  or  some  similar  climate  and  live  out  of  doors  if  he  ex- 
pected to  live  at  all.  He  took  counsel  with  himself,  bought  a 
lot  in  the  outskirts  of  the  city,  on  which  were  some  large  trees,  and 
had  a  carpenter  build  him  two  or  three  rooms  in  the  trees.  Here 
he  lived,  with  a  man-of-all-work  to  cook  for  him  and  look  after 
his  quaint  establishment,  for  many  years.  In  the  end  he  came  to 
like  the  tree  house  so  well  that  when  he  had  completely  recovered 
and  had  accumulated  money  to  retire  on,  he  built  himself  another 
house  in  a  tree,  out  in  the  country,  where  he  went  on  living  in  a 
peaceful  and  hale  old  age. 

In  some  way  or  other  it  is  possible  for  a  determined  person  to 
get  the  needed  fresh  air  and  exercise  to  cure  consumption.  A 
disease  so  widespread  and  so  prolific  of  germs  as  tuberculosis  is,  will 
cause  so  much  trouble  if  allowed  to  run  its  course  that  it  is  economy 
for  the  state  to  step  in  and  cure  it ;  and  this  the  state,  the  city, 
and  many  large  corporations  now  perceive. 


CHAPTER  TWENTY-TWO 

TYPHOID  FEVER  AND  PNEUMONIA 

Two  of  the  diseases  which  it  is  most  important  for  the  home 
nurse  to  understand  are  typhoid  fever  and  pneumonia.  Both  are 
highly  infectious,  and  in  both  the  recovery  of  the  patient  depends 
very  much  upon  the  nursing.  Moreover,  the  conditions  which 
predispose  to  contagion  in  the  case  of  these  two  diseases  are  very 
common,  and  infection  can  often  be  avoided  by  the  use  of  simple 
precautions.  Finally,  the  home  nurse  is  likely  to  have  a  case  of 
one  or  the  other  on  her  hands  at  some  time.  A  mild  case  of  typhoid 
fever  can  sometimes  be  taken  care  of  without  employing  a  trained 
nurse;  and  pneumonia  comes  on  so  suddenly  and  is  so  serious  in 
its  first  stages  that  it  may  not  be  possible  to  get  a  trained  nurse 
until  the  disease  is  well  under  way.  Even  when  a  trained  nurse 
is  employed,  the  necessity  for  constant  care  is  such  that  some 
member  of  the  family  is  almost  always  called  upon  to  assist  in 
the  care  of  the  patient,  and  the  more  intelligent  the  amateur  nurse 
proves  the  better  it  is  both  for  the  patient  and  the  trained  nurse. 
It  is  one  of  the  most  restful  and  comforting  things  in  the  world 
for  a  nurse  to  find  that  a  person  who  is  willing  to  help  is  really  going 
to  be  a  help  and  not  an  added  responsibility.  . 

Choosing  and  caring  for  the  sick  room.  The  proper  selection  of 
a  room  for  a  patient  suffering  from  typhoid  fever  or  pneumonia  is 
very  important.  It  is  especially  desirable  that  the  room  of  a  typhoid 
patient  be  next  to  a  bathroom,  in  a  quiet  part  of  the  house.  Sweep- 
ing should  be  done  with  a  damp  broom  or  with  a  broom  covered 
with  a  damp  cloth,  and  dusting  with  a  damp  cloth ;  or  an  oiled  mop 
and  dustcloth  may  be  used.  If  the  patient  is  nervous  or  delirious, 
it  is  often  better  for  the  nurse  to  take  care  of  the  room  herself.  All 
food  and  medicines  should  be  given  regularly,  and  exactly  ac- 
cording to  the  directions  of  the  physician.  The  whole  plan  of 
the  treatment  may  be  disarranged  if  some  apparently  trifling  thing 
is  omitted  or  changed.  In  fact,  it  may  be  said  that  there  are  no 
trifling  things  in  the  business  of  nursing. 

165 


1 66          Personal  Hygiene  and  Home  Nursing 

TYPHOID   FEVER 

In  the  United  States  typhoid  fever  holds  the  fourth  place  as  a 
cause  of  mortality  among  communicable  diseases.  The  germ 
is  taken  into  the  body  through  the  mouth  and  thrown  out  in  the 
excreta.  It  is  found  in  the  blood  and  in  the  intestine,  in  the  spleen, 
the  liver,  and  other  parts  of  the  body.  It  attacks  the  intestine, 
particularly  in  the  lower  portion  of  the  ileum,  in  the  parts  called 
"  Peyer's  patches."  The  incubation  period  is  ten  days  to  three 
weeks.  The  germ  may  live  for  a  long  time  in  milk,  but  it  dies 
quickly  if  exposed  to  sunlight  and  air.  In  water  it  lives  for  only 
about  seven  days.  Many  cases  of  typhoid  fever  are  found  among 
persons  who  have  been  away  from  home  for  the  summer  or  for  a 
few  weeks,  the  disease  being  contracted  by  drinking  infected  water 
or  milk,  and  appearing  after  they  return  home.  A  considerable 
number  of  persons  who  have  typhoid  fever  still  carry  the  germs 
after  convalescence,  sometimes  for  several  months  and  sometimes 
as  long  as  the  person  lives. 

Symptoms  and  course  of  the  disease.  The  first  symptoms  of 
typhoid  fever  are  headache,  nausea,  pain  in  the  back,  legs,  and 
abdomen,  loss  of  appetite,  sometimes  bleeding  from  the  nose, 
constipation  followed  by  diarrhea,  coated  tongue,  and  a  charac- 
teristic rash  which  appears  generally  upon  the  abdomen.  Later 
in  the  disease  the  physician's  examination  will  reveal  an  enlarged 
spleen  and  the  germ  in  the  blood.  The  stools  become  liquid  and 
of  the  color  of  pea  soup.  The  temperature  rises  steadily,  reaching 
103°  or  104°  at  about  the  end  of  the  first  week,  remains  at  this 
point  for  three  weeks,  and  then  begins  to  decline.  In  some  cases 
the  fever  ends  in  two  weeks,  and  in  others  it  continues  to  the  fifth 
or  sixth  week ;  but  in  a  normal  case  of  typhoid  the  temperature 
should  begin  to  go  down  by  the  fourth  week,  a  little  lower  each 
day,  until  the  normal  point  is  reached.  The  pulse  is  slow  in  pro- 
portion to  the  fever,  not  becoming  rapid  until  a  later  stage  of  the 
disease  or  until  the  patient  has  become  weak,  sometimes  reaching 


Typhoid  Fever  and  Pneumonia 


167 


1 68          Personal  Hygiene  and  Home  Nursing 

its  highest  rate  when  there  is  no  fever.  Any  sudden  change  in 
temperature  or  pulse  in  the  midst  of  the  illness  is  a  danger  signal. 

Typhoid  patients  are  liable  to  sudden  changes  and  relapses 
which  make  it  extremely  necessary  for  the  nurse,  even  if  she  is  in 
charge  for  only  an  hour,  to  be  thoroughly  informed  regarding  the 
nature  and  course  of  the  disease.  A  nurse  usually  instructs  the 
member  of  the  family  who  relieves  her,  as  far  as  she  can,  but  in 
the  stress  and  hurry  of  illness  it  is  not  easy  to  give  comprehensive 
instructions  even  if  one  has  a  talent  for  teaching.  The  amateur 
assistant  should  get  all  the  information  she  can  beforehand  from 
the  physician  and  the  nurse,  and  if  there  is  any  doubt  about  re- 
membering the  various  points  she  should  keep  a  notebook. 

Care  of  excreta.  The  disinfection  of  excreta  in  typhoid  cases 
is  important,  and  this  includes  urine  as  well  as  the  discharges  from 
the  bowels.  Pouring  a  disinfectant  solution  on  excreta  and  empty- 
ing the  vessel  at  once  is  not  enough ;  it  should  be  allowed  to  stand, 
covered,  for  an  hour  or  more  for  the  disinfectant  to  take  effect. 
The  best  disinfectants  for  the  bowel  movements  are  limewater, 
and  carbolic  acid  solution  with  one  part  of  acid  to  twenty  parts  of 
water,  or  formalin. 

No  bed  pan  should  be  emptied  without  careful  examination, 
and  if  there  is  any  unusual  appearance  whatever  the  stool  should 
be  saved.  As  stated  previously  (page  96),  a  doctor  or  nurse  will 
detect  signs  of  a  hemorrhage  when  the  untrained  eye  does  not. 
Blood  coming  from  the  bowels,  unless  near  the  rectum,  changes 
color  completely  before  it  is  passed. 

Bathing,  and  the  "drop."  Baths  are  given  every  two  or  three 
hours,  according  to  the  necessity  of  the  case  and  the  degree  of 
fever.  The  temperature  is  taken  upon  the  hour  indicated.  If 
the  fever  reaches  the  point  where  the  bath  is  necessary,  the  patient 
is  bathed  for  fifteen  or  twenty  minutes,  dried,  covered  up,  and 
left  to  rest  (page  119).  At  the  end  of  half  an  hour  the  temperature 
is  taken  again,  and  this  temperature  indicates  what  is  called  the 
"  drop  "  from  the  bath,  or  the  result  of  the  bath.  In  recording 


Typhoid  Fever  and  Pneumonia  169 

the  temperature,  the  "  drop  "  is  not  put  in  the  line  with  the  other 
temperature  on  the  chart,  but  is  put  directly  under  the  tempera- 
ture taken  at  the  regular  hour  before  the  bath  was  given.  Down 
from  this  we  draw  a  dotted  line  to  indicate  that  this  last  tempera- 
ture was  the  "  drop." 

Hemorrhage  in  typhoid  fever.  Hemorrhage  from  the  intestine 
is  one  of  the  common  complications  in  cases  of  typhoid.  Often 
the  first  indication  of  this  is  a  lowering  of  the  temperature.  If 
there  is  a  radical  difference  in  temperature  from  the  last  one  re- 
corded on  the  chart,  the  thermometer  should  be  well  shaken  down, 
the  mouth  examined  to  see  that  it  is  not  too  dry,  and  the  tempera- 
ture taken  again.  If  this  difference  still  appears,  the  fact  should 
be  reported  immediately  to  the  nurse,  or,  if  you  are  taking  care 
of  the  patient  without  a  nurse,  call  the  doctor.  The  blood  does 
not  always  show  at  first,  especially  if  coming  from  high  up  in  the 
intestine.  After  reporting  to  the  nurse  and  the  doctor,  place 
hot-water  bags  at  the  feet  if  they  are  cold,  and  an  ice  bag  on  the 
abdomen.  If  the  hemorrhage  becomes  excessive,  raise  the  foot  of 
the  bed.  The  patient  must  be  kept  absolutely  quiet,  and  not 
allowed  to  suppose  that  there  is  anything  wrong.  If  there  has 
already  been  a  hemorrhage  or  the  doctor  has  reason  to  fear  one, 
the  nurse  should  get  from  the  doctor  explicit  directions  for  such 
an  occurrence.  It  is  always  best  in  taking  care  of  such  a  case  to 
have  the  doctor  leave  directions  for  all  possible  emergencies  so 
that  no  time  may  be  lost  in  carrying  them  out.  At  critical  times 
the  loss  of  a  very  few  minutes  may  be  disastrous. 

Delirium.  The  typhoid  patient  should  never  be  left  alone. 
Delirium  is  often  not  recognized  immediately.  The  patient  may 
be  able  to  talk  intelligently  on  any  subject,  answering  questions 
coherently,  and  still  be  slightly  delirious.  The  delirium  shows 
at  night,  as  a  rule,  and  often  takes  the  form  of  wanting  to  get  out 
of  bed ;  in  many  cases  the  patient  has  a  persistent  idea  that  there 
is  something,  either  business  or  pleasure,  which  he  must  get  out 
and  attend  to.  The  patient  does  not  always  speak  of  this  idea, 


170          Personal  Hygiene  and  Home  Nursing 

but  when  left  alone  he  immediately  takes  the  opportunity  to  get 
up  and  try  to  carry  it  out,  often  with  serious  and  disastrous  con- 
sequences to  himself. 

If  there  is  extreme  fever  or  delirium,  the  ice  bag  should  be  kept 
at  the  head.  The  patient  should  be  kept  quiet ;  there  should  be 
no  talking  or  whispering,  and  the  light  should  not  shine  into  the 
eyes.  The  bed  should  be  so  placed  that  the  patient  does  not  face 
the  light,  and  any  artificial  light  should  be  covered.  Not  only 
is  the  glare  of  the  light  a  strain  on  the  eyes,  but  it  may  increase 
the  tendency  to  delirium.  The  patient  should  not  be  allowed  to 
sit  up  or  move  very  much  unassisted,  as  there  is  always  danger 
of  heart  failure. 

Bed  sores.  From  the  very  beginning  of  a  case  the  possibility 
of  bed  sores  must  not  be  overlooked,  as  this  is  one  of  the  com- 
plications most  to  be  dreaded  in  typhoid  fever.  Nurses  called 
to  a  patient  after  the  disease  has  made  some  progress  often  find 
the  beginning  of  such  a  sore,  due  to  the  ignorance  of  the  family. 
The  back,  elbows,  heels,  shoulders,  and  any  part  which  presses 
against  the  bed  may  become  sore.  The  under  sheet  must  be  kept 
absolutely  smooth,  and  the  parts  of  the  body  clean  and  dry  and 
frequently  rubbed  with  alcohol  or  alcohol  and  alum.  The  rubbing 
should  be  done  in  deep,  small  circles.  The  object  of  this  is  to  keep 
up  the  circulation  of  the  blood,  as  a  bed  sore  is  due  to  the  lack  of 
circulation  caused  by  the  constant  pressure  of  the  body  against 
the  bed.  If  the  skin  is  reddened  and  shows  signs  of  becoming 
sore,  continue  the  rubbing  unless  the  skin  is  broken.  Salves  soften 
the  skin  and  encourage  the  formation  of  bed  sores,  and  should  be 
used  only  after  the  skin  is  broken.  Oxid  or  stearate  of  zinc  oint- 
ment helps  to  heal  a  broken  sore.  If  powder  is  used  on  the  back, 
rub  the  hand  over  the  powder  to  keep  it  from  forming  lumps. 
Rubber  rings  can  be  bought  to  put  under  the  back  and  keep  it 
from  pressing  against  the  bed.  Rings  to  fit  elbows,  heels,  or  any 
other  part  of  the  body  may  be  made  of  absorbent  cotton  wrapped 
with  a  bandage. 


Typhoid  Fever  and  Pneumonia  171 

Feeding  the  patient.  Physicians  disagree  more  about  the  diet, 
of  a  typhoid  patient  than  on  any  other  one  point  in  the  care  of  the 
case.  A  few  years  ago  the  patients  were  not  allowed  anything  but 
a  liquid  diet,  and  some  physicians  kept  them  on  milk  entirely, 
not  allowing  even  broths.  They  were  starved  until  they  became 
ravenously  hungry,  and  no  matter  how  honest  a  person  may  be 
when  well,  a  convalescent  who  has  been  treated  by  this  method 
will  steal  food  if  he  can  get  it.  Many  cases  of  relapse  have  come 
from  imprudent  eating  at  this  time.  At  the  present  day  many 
physicians  give  simple  foods  like  toast  and  thoroughly  cooked  rice 
and  eggs,  and  many  other  easily  digestible  soft  foods,  almost  from 
the  beginning  of  the  disease,  and  allow  the  desire  of  the  patient 
to  dictate  in  some  degree  the  choice  of  food.  During  the  early 
stages  of  the  disease,  when  they  have  no  desire  for  food,  they  are 
given  liquids  in  moderation;  but  when  the  appetite  revives  and 
the  patient  asks  for  food,  easily  digested  semi-solid  food  is  given. 
Some  doctors  give  meat  which  has  been  ground  fine  and  made 
into  cakes.  The  convalescence  of  a  patient  fed  in  this  way  is 
much  more  normal,  the  appetite  is  not  excessive,  the  patient  will 
eat  as  directed,  and  will  recover  from  the  disease  in  a  better  con- 
dition, stronger  and  less  emaciated.  Physicians  who  use  this 
method  contend  that  there  are  no  more  cases  of  relapse  than  under 
the  old  method  of  feeding.  Water  is  given  regularly  and  abun- 
dantly. 

Precautions  to  be  taken  by  the  nurse.  The  nurse  should  take 
every  care  to  avoid  contracting  the  disease,  never  lying  down  on 
the  bed  beside  the  patient,  never  eating  food  left  in  the  room, 
disinfecting  her  hands  after  emptying  vessels  or  handling  the 
patient,  going  out  into  the  fresh  air  each  day,  and  disinfecting 
mouth  and  throat  before  eating.  Inoculation  with  typhoid  vaccine 
is  also  most  desirable. 

Typhoid  vaccination.  The  value  of  vaccination  or  inoculation 
in  typhoid  fever  is  an  established  fact.  It  was  introduced  into 
the  English  army  by  Sir  Almoth  Wright,  and  met  with  such  success 


172          Personal  Hygiene  and  Home  Nursing 

that  it  was  soon  used  in  the  armies  of  other  countries.  It  was  used 
first  in  the  United  States  army  in  1909,  and  at  that  time  only 
soldiers  voluntarily  submitting  to  the  treatment  were  vaccinated. 
The  results  were  so  satisfactory  that  in  1911  it  was  made  com- 
pulsory for  all  soldiers  under  forty-five  years  of  age.  The  im- 
mediate decrease  in  the  number  of  cases  and  deaths  was  marked, 
and  in  1913  not  one  death  occurred  in  the  United  States  army  from 
typhoid  fever.  Nurses  and  doctors  in  many  of  the  large  hospitals 
are  vaccinated  against  typhoid,  and  some  railroads  and  mills 
encourage  vaccination  among  their  employees.  Children  are 
peculiarly  liable  to  the  disease,  and  it  is  an  excellent  plan  to  have 
them  vaccinated  every  four  years. 

It  is  not  yet  known  how  many  years  the  immunity  due  to  the 
effects  of  the  inoculation  actually  lasts,  but  in  the  army  it  is  con- 
sidered best  to  repeat  it  every  four  years.  This  rule  is  a  good  one, 
and  if  one  is  nursing  a  case  of  typhoid  fever  or  going  to  some 
place  of  uncertain  sanitary  conditions,  it  would  be  well  to  be 
revaccinated  after  a  shorter  interval. 

Directions  for  using  the  vaccine.  Three  doses  of  typhoid 
vaccine  are  given  at  intervals  of  from  seven  to  ten  days.  The 
best  hour  to  take  it  is  late  in  the  afternoon,  for  as  the  reaction  does 
not  begin  until  three  or  four  hours  after  the  dose  is  given,  the 
effects  will  be  felt  at  about  the  hour  for  retiring  and  will  wear  off 
before  morning.  One  should  not  exercise  violently  after  taking 
the  dose,  and  it  should  not  be  given  to  a  woman  immediately  be- 
fore or  during  menstruation. 

The  effect  upon  the  system  varies  with  the  individual.  There 
may  be  a  rise  in  temperature  to  101°  or  103°,  but  in  many  cases 
there  is  merely  a  feeling  of  discomfort.  There  is  a  greater  reaction 
after  the  first  and  the  second  dose  than  after  the  third.  With 
children,  there  are  practically  no  bad  effects,  though  there  is  some- 
times a  slight  local  irritation  at  the  point  of  injection.  This  in- 
flammation may  spread  to  the  nearest  lymph  glands.  It  lasts 
only  from  twenty-four  to  forty-eight  hours. 


Typhoid  Fever  and  Pneumonia  173 

PNEUMONIA 

In  addition  to  other  interesting  and  important  work  that 
has  been  and  is  being  done  in  the  Rockefeller  Institute  for 
Medical  Research  in  New  York,  much  time  has  been  given  to 
the  study  of  pneumonia,  its  causes  and  treatment.  As  a 
result  of  this  and  other  studies  certain  conclusions  may  be 
reached : 

(1)  The  majority  of  cases  of  pneumonia  are  due  to  the  presence 
of  pneumonia  germs  (pneumococci)  of  especially  virulent  strains 
which  have  been  acquired  by  the  patient  from  direct  contact  with 
some  one  else  suffering  from  the  disease. 

(2)  A  small  percentage  of  pneumonia  cases  are  due  to  varieties 
of  pneumococci  of  low  virulence  which  are  found  in  the  mouths 
and  throats  of  many  healthy  individuals. 

(3)  Attacks  caused  by  the  more  virulent  strains  of  germs  are 
generally  severe,  and  the  percentage  of  deaths  is  large. 

(4)  Cases  caused  by  the  less  virulent  and  more  widely  dis- 
tributed varieties  of  the  germ  are  of  moderate  severity,  and  the 
percentage  of  deaths  is  low. 

.(5)  Lowered  bodily  resistance  increases  the  tendency  to  the 
development  of  the  disease  with  both  kinds  of  germs,  but  this  is 
more  true  of  the  second  type  than  of  the  first ;  for  with  the  more 
virulent  type  of  germ  the  presence  of  the  germs  is  of  great  im- 
portance and  may  determine  the  onset  of  the  disease,  however 
strong  and  vigorous  a  person  may  be. 

(6)  The  disease  should  be  considered  infectious,  like  any  other 
communicable  disease.  Physicians  should  be  required  to  report 
cases  to  the  health  authorities,  and  isolation  of  the  patient  should 
be  strict. 

Among  other  causes  of  lowered  bodily  resistance  are  chilling  of 
the  body,  excessive  fatigue,  previous  disease,  "  colds,"  and  ex- 
cessive use  of  alcohol.  The  larger  number  of  pneumonia  cases 
among  men  is  probably  due  to  the  lowering  of  bodily  resistance 


174          Personal  Hygiene  and  Home  Nursing 

by  fatigue  and  the  use  of  alcohol.  Cases  of  so-called  "  alcoholic 
pneumonia  "  are  particularly  fatal. 

Symptoms  and  nursing  of  pneumonia.  In  most  cases  of  pneu- 
monia the  attack  comes  suddenly,  starting  with  pain  in  the  lungs, 
a  chill,  a  cough,  rapid  breathing,  flushed  cheeks,  and  abnormally 
dry  skin.  The  temperature  runs  up  to  104°  or  106° ;  the  respira- 
tion is  very  rapid,  often  going  as  high  as  50.  Fever  continues  from 
three  to  ten  days  and  usually  abates  quickly,  or  by  crisis.  At 
the  time  of  this  crisis  the  patient  must  be  carefully  watched,  for 
although  it  is  only  one  stage  of  the  disease,  the  drop  in  temperature 
is  frequently  accompanied  by  extreme  prostration  and  it  is  there- 
fore a  critical  time  for  the  patient.  Heat  should  be  applied  ex- 
ternally, the  pulse  carefully  watched,  and  a  stimulant  given  if 
necessary.  The  patient  should  be  kept  as  quiet  as  possible 
and  disturbed  for  baths  and  treatment  only  when  absolutely 
necessary. 

Delirium  often  comes  early  and  continues  well  into  the  disease. 
The  patient  must  be  carefully  watched  to  prevent  his  getting  out 
of  bed  or  sitting  up  suddenly,  as  in  every  case  of  pneumonia  there 
is  much  danger  of  heart  failure.  An  ice  bag  should  be  kept  upon 
the  head,  and  if  the  delirium  becomes  excessive  a  cold  sponge 
bath  may  be  given.  The  fresh-air  treatment  is  used,  and  the 
patient  must  be  protected  against  the  cold  with  light-weight 
woolen  'covers  and  wraps.  The  strength  must  be  kept  up  by 
nourishing,  digestible  food,  but  overfeeding  should  be  avoided. 
The  bowels  should  move  regularly,  and  no  distention  of  the  ab- 
domen be  permitted,  as  the  pressure  of  gas  in  the  intestine  will 
increase  difficulty  in  breathing.  The  disease  will  run  its  own  course, 
ending  naturally,  and  the  chief  aim  of  medical  care  and  nursing 
is  to  give  the  patient  strength  to  make  a  fight.  Plenty  of  water 
should  be  given,  as  the  poison  is  in  this  way  eliminated  by  the 
kidneys  and  through  the  skin.  As  the  germ  is  found  in  the  sputum, 
the  same  care  must  be  taken  in  disinfection  as  in  the  case  of  diph- 
theria and  tuberculosis.  If  not  guarded  against,  the  disease  may 


Typhoid  Fever  and  Pneumonia  175 

spread  to  other  members  of  the  family,  and  the  nurse  may  find 
herself  called  on  to  care  for  two  or  three  patients  instead  of  one. 

Treatment  of  pneumonia  with  serum.  An  anti-pneumococcus 
serum  made  by  a  method  perfected  by  the  Rockefeller  Institute 
for  Medical  Research  has  been  used  successfully  in  the  treatment 
of  pneumonia  cases  caused  by  certain  varieties  of  the  germ.  This 
treatment  has  reduced  the  mortality  among  the  cases  produced 
by  one  especially  virulent  strain  of  the  germ  from  30  per  cent  to 
5  per  cent,  but  does  not  give  protection  against  other  strains. 
After  an  injection  of  the  serum  the  patient's  temperature  will 
decrease  two  or  three  degrees,  and  there  is  also  a  decrease  in  pain 
and  in  the  difficulty  in  breathing.  The  crisis  is  usually  hastened 
and  the  course  of  the  disease  shortened.  Experiments  are  under 
way  determining  its  use  as  a  prophylactic  (preventive),  and  it  is 
thought  that  it  can  be  made  most  useful  as  a  preventive  during 
an  epidemic.  Immunity  given  by  the  use  of  this  serum  lasts 
only  about  three  months.  It  is  hoped  that  this  treatment  can  be 
developed  until  it  will  be  effective  against  all  varieties  of  the 
germ. 


CHAPTER  TWENTY-THREE 
NON-COMMUNICABLE  DISEASES  CAUSED  BY  BACTERIA 

THERE  has  been  within  the  past  few  years  a  great  advance  in 
our  knowledge  of  chronic  diseases  like  rheumatism,  arthritis 
deformans  (rheumatoid  arthritis),  and  diseases  of  the  heart,  kid- 
neys, and  arteries ;  and  many  cases  of  these  diseases  which  a  few 
years  ago  would  have  been  considered  hopelessly  incurable  are 
greatly  benefited  if  not  cured  by  modern  methods  of  treatment. 
There  is  still  a  difference  of  opinion  among  physicians  as  to  the 
causes  of  a  number  of  these  maladies,  but  that  many  diseases 
besides  those  listed  as  "  communicable  diseases  "  are  caused  by 
bacteria,  is  now  an  accepted  fact.  Such  men  as  Dr.  Billings  and 
Dr.  Rosenow  have  proved  that  groups  of  bacteria  may  live  and 
grow  for  long  periods  in  certain  tissues  and  organs  of  the  body, 
and  that  from  these  foci  or  centers  of  infection  bacteria  are  carried 
through  the  body  in  the  blood  and  settle  at  different  points,  caus- 
ing disease.  Because  early  diagnosis  plays  an  all-important  part 
in  the  prevention  and  relief  of  the  diseases  caused  by  these 
bacteria,  and  because  many  persons  fail  to  consult  a  physician 
until  important  organs  have  become  infected  and  the  disease  has 
materially  progressed,  I  have  included  this  discussion  of  the  sub- 
ject, hoping  to  emphasize  the  necessity  of  early  consultation  with 
a  physician  in  cases  of  this  kind. 

Diseases  due  to  chronic  infections.  Bacteria  may  live  for  an 
indefinite  length  of  time  in  the  tonsils,  nasal  sinuses,  around  the 
roots  of  the  teeth  and  in  the  bones  of  the  jaws  and  face,  and  in 
chronic  abscesses  such  as  are  sometimes  found  in  the  lungs  or 
pleural  cavities  after  pneumonia.  Acute  diseases  caused  by 
bacteria  from  these  foci  of  infection  are  gastric  and  intestinal 
ulcers,  rheumatic  fever,  appendicitis,  inflammation  of  the  gall 
bladder,  acute  arthritis  (inflammation  of  the  joints),  and  inflamma- 
tion of  the  membranes,  lining,  and  covering  of  the  heart.  Among 
the  chronic  diseases  of  which  many  cases  at  least  are  probably 
caused  by  this  mode  of  infection  are  arthritis  deformans,  chronic 

176 


Non-Communicable  Diseases  Caused  by  Bacteria     177 

nephritis  (inflammation  of  the  kidneys),  diseases  of  the  walls  of 
the  heart,  and  arteriosclerosis  (hardening  of  the  arteries). 

Early  diagnosis  is  most  important  with  these  cases,  so  that  the 
seat  of  the  infection  may  be  found  and  removed,  and  one  should 
never  abandon  hope  until  all  possible  sources  of  infection  have 
been  proved  neutral.  The  teeth  should  be  examined  by  an 
expert  dentist  who  has  made  a  specialty  of  this  line  of  work.  A 
throat  specialist  should  look  for  adenoids  and  diseased  tonsils, 
for  many  tonsils  that  appeared  healthy  on  casual  examination  have 
later  proved  to  be  foci  of  infection.  According  to  Dr.  Frank 
Billings,  who  has  done  such  wonderful  work  along  these  lines, 
"  The  failure  to  find  a  focus  in  the  expected  situation  should  in- 
dicate an  extension  of  the  field  of  examination  until  it  shall  have 
been  found." 

Arteriosclerosis.  Arteriosclerosis,  or  hardening  of  the  arteries, 
is  a  disease  which  indirectly  kills  the  majority  of  older  people. 
It  is  primarily  a  disease  of  the  blood  vessels  and  walls  of 
the  heart.  The  walls  of  the  arteries  may  be  thickened  and 
hardened  by  a  deposit  of  lime  salts  along  their  whole  length, 
or  this  thickening  may  occur  only  in  certain  sections  of  an 
artery  or  in  spots.  Sometimes  the  thickening  will  take  place  at 
the  point  where  another  artery  branches  off  and  the  circulation 
of  blood  through  the  branch  artery  may  be  retarded. 

Arteries  which  have  become  thickened  lose  much  of  their  elas- 
ticity, and  these  conditions  increase  the  work  that  the  heart  has  to 
do  to  force  blood  through  the  vessels.  At  the  same  time  that  the 
heart  may  be  doing  this  extra  work,  its  walls  may  be  weakened 
and  lessened  because  of  the  sclerotic  condition  of  the  arteries  carry- 
ing blood  to  them.  Some  of  the  results  of  this  change  in  the  walls 
of  the  arteries  are  aneurisms  or  saclike  bulgings  on  the  weakened 
arterial  walls ;  apoplexy,  which  is  due  to  the  bursting  of  a  blood 
vessel  in  the  brain ;  diseases  of  the  heart,  kidneys,  and  liver,  which 
are  due  either  to  the  deficient  blood  supply  these  organs  receive 
through  the  hardened  arteries  or  to  the  same  causes  as  the  disease 


178          Personal  Hygiene  and  Home  Nursing 

in  the  arteries  themselves ;  and  a  general  aging  of  the  tissues  and 
breaking  down  of  the  health. 

Arteriosclerosis  may  be  due  to  a  number  of  different  causes. 
Sometimes  it  follows  attacks  of  typhoid  fever  or  gout;  often  it 
is  the  result  of  bacteria  carried  from  chronic  foci  of  infection 
within  the  body.  Among  the  poisons  which  cause  it  are  alcohol 
and  (probably)  the  excessive  use  of  tobacco.  Long-continued 
hard  work,  overeating,  and  worry  will  help  to  wear  out  the  arteries. 
Some  cases  of  the  disease  are  due  to  inherited  weak  vessels,  age, 
or  the  wear  and  tear  on  the  arteries  incident  to  daily  life,  but  many 
cases  are  due  to  causes  that  are  within  our  control. 

The  first  step  in  treating  the  disease  is  to  remove  the  cause; 
stop  the  use  of  alcohol  and  tobacco  and  remove  the  focus  of  in- 
fection if  one  can  be  found.  The  walls  of  the  arteries  cannot  be 
restored  to  their  normal  condition  after  being  damaged,  but  danger 
from  this  condition  may  be  reduced  by  keeping  the  bowels  open, 
the  skin  in  good  condition  by  baths,  and  avoiding  overeating, 
violent  exercise,  excessive  work,  worry,  and  excitement. 

Rheumatism  or  acute  rheumatic  fever.  Rheumatic  fever  is 
an  acute  inflammation  of  the  joints,  accompanied  by  high  fever 
and  an  excessive  amount  of  pain.  It  is  believed  to  be  caused  by  a 
germ  brought  from  some  part  of  the  body,  often  from  the  tonsils. 
As  a  rule  more  than  one  joint  is  affected,  but  not  all  at  once  — 
a  second  joint  swelling  as  the  first  improves.  There  is  complete 
recovery  from  the  disease,  with  no  stiffness  as  a  result. 

The  complications  following  the  disease  are  more  dangerous 
than  the  disease  itself.  Of  these  heart  disease  is  the  most  serious. 
Sometimes  it  is  of  a  form  which  is  apparently  light  at  first  but 
develops  later  into  a  serious  condition.  Chorea  (St.  Vitus's  dance) 
is  a  common  complication.  Tonsillitis,  which  is  frequently  present 
at  the  same  time,  is  known  now  to  be  the  cause,  not  the  result,  of 
the  attack  of  rheumatic  fever. 

In  nursing  a  case  of  this  kind,  great  care  must  be  taken  not  to 
move  the  bed.  Touch  the  patient  gently  and  only  when  ab- 


Non- Communicable  Diseases  Caused  by  Bacteria     179 

solutely  necessary ;  even  unnecessary  walking  around  the  room 
should  be  avoided.     If  the  weight  of  the  bedclothes  gives  pain, 


FIG.  62.  In  cases  of  illness  the  weight  of  the  bedclothes  is  sometimes  discomforting 
to  the  patient.  The  figure  shows  an  apparatus  made  from  barrel  hoops  that  can  be 
used  to  carry  the  weight  of  the  covers. 

they  should  be  supported  by.  a  frame  which  can  be  bought  at  an 
instrument  store  or  made  of  barrel  staves  cut  in  half  and  nailed 
or  tied  to  a  strip  of  board. 

The  throat  should  be  treated,  and  as  soon  as  possible  the  tonsils 
removed.  Diluted  milk  diet  is  given,  and  water  should  be  drunk 
in  large  quantities.  Hot  and  cold  compresses  may  be  used  to 
relieve  the  pain  in  the  joints.  The  patient  should  not  be  allowed 
even  to  sit  up  in  bed  until  the  doctor  considers  it  absolutely  safe, 
as  the  heart  is  much  affected  by  the  disease  and  many  cases  of 
heart  injury  can  be  prevented  if  proper  care  is  used  during  con- 
valescence. 

Arthritis  deformans.  This  disease  is  commonly  called  either 
rheumatism  or  rheumatoid  arthritis.  Its  cause  is  not  surely  estab- 
lished, but  there  is  much  room  to  believe  that  it  is  due  to  germs 
from  some  focus  of  infection  such  as  the  roots  of  teeth,  infected 
tonsils,  or  infected  nasal  sinuses.  The  attacks  may  come  on  slowly 
or  start  suddenly  like  rheumatic  fever.  It  affects  all  the  joints, 
large  and  small.  In  some  cases  there  is  a  great  deal  of  pain,  in 
others  little  or  no  pain.  Gradually  the  joints  stiffen  and  as  a  rule 


180          Personal  Hygiene  and  Home  Nursing 

increase  in  size  because  of  the  growth  of  new  soft  and  bony 
tissue. 

For  many  years  little  attempt  was  made  even  to  check  the 
progress  of  the  disease,  for  nothing  was  known  of  its  cause.  The 
treatment  generally  followed  was  one  of  diet  and  medicines,  neither 
of  which  had  an  influence  over  the  disease  and  generally  upset  the 
stomach  of  the  patient  and  made  life  only  so  much  the  harder. 
Today  there  is  still  a  great  difference  of  opinion  among  the  mem- 
bers of  the  medical  profession  as  to  treatment,  but  they  agree  upon 
one  fact,  that  sources  of  infection  must  be  diligently  sought  out 
and  removed.  If  the  disease  is  taken  in  its  early  stages  and 
promptly  treated,  much  can  be  done  to  check  it.  Several  cases 
have  come  under  my  direct  observation  in  which  immense  relief 
was  given.  One  case,  a  woman  over  sixty  years  old,  who  had 
suffered  from  chronic  bronchitis  for  many  years  and  arthritis  for 
eighteen  years,  had  gradually  become  so  crippled  that  she  was 
obliged  to  use  crutches  and  never  went  into  the  street  alone.  After 
two  years  of  massage  and  forcible  exercises,  hot-air  baking,  and 
injection  of  vaccines  prepared  with  cultures  from  her  own  throat, 
she  was  able  to  give  up  her  crutches  and  use  a  cane,  and  went  up 
and  down  stairs  freely  and  out  on  the  street  alone.  Her  joints 
became  more  flexible  and  less  painful,  and  her  bronchitis  was 
much  improved.  Other  cases  of  shorter  duration  have  been  checked 
by  removal  of  the  tonsils  and  treating  or  removing  the  teeth. 

At  one  time  it  seemed  as  if  the  vaccine  treatment  was  to  be  the 
remedy  for  chronic  cases  of  this  disease,  but  it  fails  in  numerous 
instances  and  now  many  physicians  do  not  believe  in  it  at  all,  but 
consider  that  the  improvement  in  such  cases  as  the  one  given  above 
has  been  the  result  of  the  treatment  of  the  source  of  the  infection 
and  the  general  good  care  and  special  treatment  given  to  develop 
the  muscles  and  improve  the  joints.  Upon  one  point,  however, 
all  physicians  agree:  it  is  necessary  to  search  for  the  focus  of 
infection  and  remove  it  when  found,  and  the  sooner  this  is  done 
the  more  sure  the  result  will  be. 


Non-Communicable  Diseases  Caused  by  Bacteria     181 

Those  cases  which  have  gone  beyond  the  first  stages  of  the  disease 
should  not  abandon  all  treatments,  for  though  a  cure  may  not  be 
made  there  is  always  the  possibility  that  by  getting  rid  of  the 
focus  of  infection  the  progress  of  the  disease  will  be  checked  and 
some  relief  from  the  pain  and  discomfort  present  in  these  cases 
will  be  given.  Food  has  practically  no  effect  upon  the  disease, 
and  as  the  appetite  is  sometimes  uncertain  with  these  patients  it 
is  best  not  to  limit  the  variety  of  their  food.  Massage  and  passive 
and  active  movements  of  the  joints  help  to  prevent  the  stiffening 
of  the  joints  and  keep  up  the  tone  of  the  muscles. 

Other  chronic  diseases  caused  by  bacteria.  Among  other 
chronic  infections  may  be  mentioned  Bright's  disease,  heart  dis- 
ease, and  St.  Vitus's  dance.  The  latter  is  believed  to  be  due  to 
the  invasion  of  the  central  nervous  system  by  germs  of  the  same 
kind  that  cause  the  other  diseases  discussed  in  this  chapter.  The 
teeth  and  tonsils  of  any  one  suffering  from  this  ailment  should  be 
examined  to  see  if  the  primary  focus  of  infection  is  in  these  parts. 


CHAPTER   TWENTY-FOUR 
FOOD   FOR  THE  INVALID 

THE  ability  to  prepare  food  for  an  invalid  is  one  great  test  of 
the  fitness  of  a  nurse  for  her  profession.  It  may  demand  in  some 
cases  not  only  a  knowledge  of  food  values  and  skill  in  cookery,  but 
an  intuition  as  to  what  will  please  the  taste  of  the  patient. 
Particularly  in  tuberculosis  and  other  wasting  diseases,  the 
appetite  has  to  be  tempted  and  the  food  varied,  and  recovery 
may  in  great  measure  depend  on  the  nourishment  that  the 
patient  receives. 

Punctuality.  One  all-important  point  in  serving  an  invalid  is 
to  have  the  meals  on  time.  Promptly  at  the  hour  when  the  tray 
is  due,  it  should  appear.  Nothing  is  more  trying  to  a  sick  person 
than  to  have  to  wait  for  a  meal.  It  is  a  good  idea  to  plan  your 
menus  at  least  twenty-four  hours  ahead,  so  that  you  will  be  sure 
to  have  your  materials  in  the  house ;  then  there  will  be  no  delay 
from  waiting  for  them  to  be  delivered. 

The  serving  tray.  There  are  two  convenient  types  of  invalid 
trays  which  can  be  bought.  One  is  the  tray  made  to  sit  on  the 
bed ;  the  other  stands  on  the  floor  with  the  supporting  part  under 
the  bed  and  the  tray  over  the  patient.  The  latter  form  is  ad- 
justable and  is  the  more  convenient,  but  is  a  little  more  expensive 
than  the  bed  tray.  If  the  patient  must  eat  in  her  room  for  a  long 
time,  the  comfort  which  a  good  tray  will  give  overbalances  the 
original  cost  of  the  tray. 

Preparing  the  tray.  The  preparation  of  the  tray  is  almost  as 
important  as  the  preparation  of  the  food  itself;  for,  frequently, 
the  first  appearance  of  the  tray,  as  it  is  brought  into  the  room, 
helps  to  determine  whether  the  patient  will  or  will  not  eat  with 
appetite.  The  linen  should  be  of  the  daintiest.  The  china  should 
be  the  prettiest  in  the  house,  —  thin,  dainty,  and  varied.  Many 
times  a  patient  can  be  tempted  to  take  food  merely  because, 
where  yesterday  she  took  it  from  a  blue  cup,  today  she  is 
taking  it  from  a  pink  one,  or  because  something  has  been  done 

182 


Food  for  the  Invalid  183 

to  show  that  the  nurse  has  given  thought  to  the  preparation  of 
her  tray. 

In  arranging  the  tray,  place  yourself  before  it  and  make  sure 
that  china  and  silver  and  everything  on  it  are  as  carefully  placed  as 
they  would  be  on  a  table.  Let  the  glass  and  cup  be  on  the  proper 
side,  the  knives  and  forks  placed  as  they  should  be,  and  everything 
arranged  so  that  there  need  be  no  changes  made  at  the  side  of  the 
patient.  See  that  everything  needed  is  on  the  tray.  An  invalid 
may  lose  all  appetite  and  refuse  to  eat  through  having  to  wait 
while  the  nurse  goes  to  find  the  necessary  salt,  pepper,  spoon,  or 
something  else  which,  through  carelessness,  has  been  omitted. 

Always  go  cheerfully  to  prepare  the  tray.  There  is  nothing 
that  makes  an  invalid  feel  more  depressed  than  to  see  the  nurse 
or  the  member  of  the  family  who  is  going  to  prepare  her  food  sigh 
and  wonder  what  she  can  get  for  her  next.  She  feels  that  she 
does  not  want  to  eat  anyway,  and  if  it  is  so  much  trouble  she  would 
rather  do  without.  If  you  wish  her  to  enjoy  her  food,  show  her 
that  you  take  pleasure  in  the  preparation  of  it. 

Details  of  service.  Take  care  that  the  food  that  is  to  be  hot  is 
hot,  and  the  food  that  is  to  be  cold  is  cold.  If  the  kitchen  is  far 
from  the  bedroom,  a  little  ingenuity  may^be  necessary  in  keeping 
food  hot.  Carry  the  broth  or  soup  in  a  cup  sitting  in  a  bowl  of 
hot  water.  Warm  the  plate  for  the  meat  or  vegetables  and  cover 
them  with  a  hot  plate,  or  use  a  dish  that  has  a  water  receptacle 
under  it  for  keeping  it  hot  or  cold.  It  is  well  to  have  a  little  stove 
(gas,  alcohol,  or  electric)  on  the  same  floor  as  the  sick  room,  so 
that  food  may  be  reheated  if  necessary;  for  to  an  invalid  half- 
warm  food  is  unpalatable.  Frequently  the  placing  of  a  flower 
upon  the  tray,  or  doing  anything  that  shows  that  it  has  been  a 
pleasure  and  interest  to  you  to  prepare  it,  will  help  to  tempt  the 
appetite. 

To  eat  alone  is  to  many  invalids  a  peculiarly  dismal  experience, 
and  if  the  food  can  be  made  to  show  the  personal  touch,  and  to 
give  the  idea  that  some  one  has  thought  out  the  details  and  taken 


184          Personal  Hygiene  and  Home  Nursing 

pains  to  please,  there  is  a  kind  of  companionship  in  the  very 
thought  of  it. 

Planning  menus.  Never  ask  a  patient  what  she  would  like  to 
eat.  As  soon  as  she  is  asked  that,  she  does  not  want  anything. 
If  she  expresses  a  desire  for  one  particular  thing,  unless  it  is  for- 
bidden, get  it  if  possible.  Give  as  great  a  variety  of  food  and 
combinations  of  foods  as  your  diet  list  will  allow.  If  you  know 
of  certain  foods  which  the  patient  fancies,  do  not  give  them  too 
frequently,  but  hold  them  in  reserve  for  the  days  when  she  is 
depressed  and  below  par.  Never  give  anything  that  is  not  per- 
mitted by  the  doctor,  but  stick  absolutely  to  his  diet.  Some- 
times one  indulgence  in  something  that  is  not  exactly  digestible 
may  undo  the  work  of  the  doctor  for  days  or  eVen  weeks. 

Providing  the  right  quantity.  When  the  quantity  is  to  be 
limited,  as  is  sometimes  the  case  in  the  excessive  hunger  of  typhoid 
fever,  never  put  more  upon  the  tray  than  the  patient  may  eat. 
There  is  nothing  more  exasperating,  when  you  are  so  hungry  that 
you  want  to  eat  everything  you  see,  than  to  have  part  of  it  carried 
away.  Let  the  patient  feel  that  she  may  eat  everything  that 
is  on  the  tray.  Occasionally,  if  the  patient  does  not  have  a 
communicable  disease,  the  nurse  may  bring  up  enough  for  two 
and  take  a  meal  with  the  invalid;  or  she  may  suggest  that  a 
member  of  the  family  shall  eat  with  her.  Where  there  is  real 
interest  and  real  desire  to  tempt  the  appetite,  there  are  many 
little  ways  in  which  the  nurse  may  help.  It  should  be  a  posi- 
tive pleasure  to  a  nurse  to  be  able  so  to  prepare  and  serve  food 
that  her  patient  cannot  resist  it,  no  matter  how  averse  to  eating 
she  felt  before  the  tray  was  brought. 

Pleasing  the  eye.  When  children  are  fed  on  a  liquid  diet,  a 
change  in  the  color  or  character  of  the  glass  often  helps  to  relieve 
the  monotony  and  tempt  the  appetite.  A  bit  of  ribbon  tied 
around  the  glass,  a  quaint  spoon,  or  some  other  little  novelty  will 
give  a  child  a  momentary  interest  and  pleasure  which  goes  a  long 
way  toward  aiding  digestion.  Milk  may  be  served  with  cream 


Food  for  the  Invalid  185 

whipped  upon  it  or  the  white  of  an  egg  beaten  into  it  to  make  it 
froth  up  so  that  it  can  be  eaten  with  a  spoon.  Individual  ice- 
cream freezers  are  to  be  had,  and  if  the  doctor  allows  it,  milk 
may  be  given  in  this  form,  seasoned  and  frozen.  Fruit  juices, 
such  as  orange  juice,  also  may  be  frozen  into  sherbets.  A  dot  of 
jelly  on  top  of  whipped  cream  adds  to  its  attractiveness,  and 
sometimes  fruit  juices  can  be  frozen  into  a  harlequin  ice  of  two  or 
three  colors. 

Liquid  diet.  The  physician  usually  directs  liquid  diets,  giving 
a  list  of  things  he  desires  to  have  used.  Common  articles  of  liquid 
diet  are  broths,  beef  extract,  tea,  milk,  gruel,  eggnog,  cream,  soups, 
cocoa,  and  buttermilk.  Albumen  water  also  is  used,  particularly 
in  nausea.  Sometimes  the  use  of  a  siphon  will  make  milk  more 
acceptable  to  the  patient.  Eggs  can  be  beaten  up  into  many 
liquid  foods  if  the  doctor  allows  it. 

Semi-liquid  diet.  In  the  semi-liquid  menu  are  included  such 
foods  as  jellies,  blancmange  made  with  gelatin  or  with  Irish  moss, 
meat  jellies,  custards,  eggs,  milk  and  cream,  toast,  asparagus, 
vegetables  put  through  a  colander,  and  strained  oatmeal.  Very 
definite  directions  should  be  secured  from  the  doctor  about  this 
diet. 

Soft  diet.  The  soft  diet  is  like  the  semi-liquid,  but  with  the 
addition  of  chicken,  scallops,  brains,  oysters,  and  creamed  dishes. 

Solid  diet.  A  solid  diet  may  include  anything  that  the  patient 
can  digest.  One  can  devise  a  variety  of  methods  of  cooking  the 
same  article  of  food.  Nurses  are  taught  to  boil  eggs  by  leaving 
them  in  hot  water  for  seven  minutes,  the  pan  having  been  removed 
from  the  stove.  This  cooks  them  smoothly  like  a  cream  with- 
out hardening  the  white,  and  makes  them  much  easier  to  digest. 
Small  omelets  cooked  in  individual  pans,  and  with  a  very  small 
amount  of  butter,  are  digestible  and  appetizing.  Shirred  eggs, 
prepared  by  breaking  the  egg  into  a  buttered  cup  and  setting  it  in 
the  oven,  ar*1  good.  Eggs  in  the  form  of  a  bird's  nest  are  at- 
tractive. To  make  these,  beat  the  white  of  the  egg,  and  when  it 


1 86          Personal  Hygiene  and  Home  Nursing 

is  like  a  meringue  put  it  in  a  buttered  plate,  rounding  it  up  and 
pressing  it  down  in  the  middle  to  make  a  hollow,  into  which  the 
unbroken  yolk  is  dropped.  The  plate  is  then  set  in  the  oven  and 
left  until  the  white  is  a  delicate  brown  and  the  yolk  slightly  cooked. 

Toast  may  be  varied  by  making  pulled  bread.  This  is  done  by 
taking  a  loaf  of  fresh  bread,  pulling  out  the  crumb,  and  putting 
it  in  a  very  slow  oven  until  it  is  crisp.  Another  attractive  way 
to  prepare  bread  is  to  cut  the  loaf  into  thin  slices,  not  cutting 
through  the  crust  at  the  back,  but  leaving  enough  of  it  whole  to 
form  a  band  to  hold  the  slices  together ;  put  a  little  butter  between 
the  slices  and  set  the  whole  in  the  oven  until  brown  and  crisp. 
Vary  the  shape  of  the  toast  by  cutting  it  into  strips  and  triangles. 

Irish-moss  blancmange.  Irish  moss  may  be  bought  at  the  drug 
store.  It  should  be  washed  and  soaked  in  cold  water,  one  sixth  of  a 
cup  of  moss  to  a  cup  and  a  half  of  water,  for  twenty  minutes  or 
half  an  hour.  Then  it  is  cooked  from  fifteen  to  twenty  minutes 
in  one  and  three-fourths  cups  of  milk  in  a  double  boiler,  first 
wrapping  the  moss  in  gauze.  It  should  be  flavored  with  vanilla 
and  set  aside  to  cool.  It  will  be  very  thin  when  first  taken 
from  the  fire,  but  when  chilled  it  becomes  firm. 

Broths.  The  simplest  and  best  way  of  making  broth  from  any 
kind  of  meat  is  to  add  a  pint  of  water  to  a  pound  of  meat,  and  let 
it  simmer  on  the  back  of  the  stove  for  about  four  hours.  At  the 
end  of  this  time  it  can  be  strained  and  will  form  a  jelly.  This  can 
be  reheated  and  given  as  a  liquid,  or  eaten  cold  as  a  jelly.  When 
beef  juice  is  ordered,  it  is  better  to  buy  a  meat  press  for  it.  The 
meat  is  cut  in  strips  and  seared  on  a  broiler,  and  the  juice  then 
squeezed  out  in  the  press.  This  beef  must  not  be  overheated  or 
the  juice  will  coagulate. 

In  preparing  food  for  the  invalid,  the  main  points  to  remember 
are :  Have  all  appointments  spotless  and  well  arranged ;  be 
punctual;  have  hot  things  hot  and  cold  things  cold;  season 
daintily;  vary  the  menus;  and  take  care  not  to  allow  any 
untidiness  in  serving  the  meal  in  the  sick  room. 


CHAPTER   TWENTY-FIVE 
ADMINISTERING  MEDICINE 

NURSING  in  one's  own  family  is  always  a  nervous  strain,  and  this 
strain  is  increased  by  the  uncertainty  that  our  ignorance  causes. 
This  is  true  when  the  amateur  nurse  is  called  upon  to  administer 
medicines.  After  the  doctor  leaves  she  can  think  of  so  many 
things  that  she  should  like  to  ask  him.  How  much  shall  the  medi- 
cine be  diluted  ?  If  one  medicine  is  to  be  given  every  three  hours 
and  one  every  four  hours,  what  shall  she  do  when  the  two  come 
together?  How  close  to  meal  time  may  the  medicine  be  given, 
and  shall  she  awaken  the  patient  when  the  hour  for  giving  the 
medicine  comes?  These  questions  and  others  will  be  answered 
here,  with  the  belief  that  such  knowledge  will  help  to  make  the 
work  of  the  home  nurse  less  trying. 

Methods  of  administration.  There  are  five  ways  of  administer- 
ing medicines:  (i)  through  the  mouth;  (2)  by  inhalation;  (3) 
by  inunction  or  rubbing  into  the  skin;  (4)  subcutaneously ;  and 
(5)  through  the  rectum.  These  methods  are  varied  according  to 
the  type  of  the  case  and  according  to  the  rapidity  with  which  the 
medicines  are  to  be  absorbed. 

Most  medicines  are  given  through  the  mouth  unless  there  is 
need  for  immediate  action.  When  given  by  this  method  they  act 
rather  slowly,  although  some  are  absorbed  into  the  blood  more 
quickly  than  others  and  thus  are  quicker  in  their  effects. 

Medicines  given  by  inhalation  reach  the  circulation  quickly,  and 
this  method  of  administration  is  sometimes  used  where  quick  action 
is  needed,  particularly  in  diseases  affecting  the  respiratory  organs. 

When  medicines  cannot  be  taken  through  the  mouth  and  imme- 
diate action  is  not  necessary,  inunction  is  sometimes  used.  This  is 
often  done  in  the  case  of  infants,  who  are  rubbed  with  olive  or  cod- 
liver  oil,  and  the  same  method  is  sometimes  used  with  adults. 

Medicines  given  subcutaneously  are  absorbed  at  once,  and  this 
method  is  used  in  cases  where  immediate  stimulation  or  other 
prompt  results  are  desired.  They  are  given  by  hypodermic 

187 


1 88          Personal  Hygiene  and  Home  Nursing 

syringe.  In  this  method  it  is  possible  to  be  absolutely  accurate  in 
the  dose  given,  as  the  entire  amount  of  a  medicine  given  in  this 
way  goes  into  the  circulation,  which  is  not  the  case  in  any  of  the 
other  methods. 

Medicines  given  by  enemas  are  absorbed  slowly,  and  much  larger 
doses  are  necessary  than  when  administration  is  through  the 
mouth. 

Time  of  giving  medicine.  All  orders  for  medicines  should  be 
written,  so  that  there  may  be  no  chance  for  a  mistake  in  the  quan- 
tity used ;  and  the  proper  time  for  giving  the  medicine  should  be 
definitely  stated  and  adhered  to.  The  time  chosen  depends  upon 
the  effect  upon  the  mucous  membrane  and  the  effect  which  it  is 
desired  to  produce  upon  the  patient. 

Medicine  to  stimulate  the  appetite  is  generally  given  before 
meals.  Alkalies,  such  as  lime,  potash,  and  magnesia,  used  to 
stimulate  the  gastric  juice,  are  given  before  eating,  but  when  used 
to  neutralize  the  acidity  of  the  gastric  juices  they  must  be  given 
after  eating.  Acids,  such  as  hydrochloric  or  muriatic,  arsenic, 
bromids  (when  given  regularly),  and  all  irritating  medicines, 
should  be  given  from  half  an  hour  to  an  hour  after  meals.  Laxa- 
tives to  act  slowly  are  given  at  night.  Those  given  to  bring 
quick  results  are  given  before  breakfast  or  when  the  stomach  is 
empty.  Hypnotics  are  given  at  night,  the  hour  depending  upon 
the  quickness  with  which  the  medicine  acts. 

Rules  for  giving  and  taking  medicines.  The  following  rules 
for  the  handling  and  use  of  medicines  will  cover  most  of  the  cases 
arising  in  an  ordinary  household : 

(1)  All  drugs  should  be  locked  up  where  no  one  can  get  at  them 
who  does  not  understand  medicines  and  their  uses. 

(2)  Poisons  and  strong  medicines  should  be  kept  separate  from 
others.     Poisons  should  be  marked  so  as  to  be  unmistakable. 
They  may  have  colored  labels  or  be  kept  in  colored  bottles,  and 
an  even  better  plan  is  to  use  bottles  of  a  distinctive  shape  which 
can  be  recognized   even   in  the  dark.     A  death's-head   label,  if 


Administering  Medicine  189 

large  enough,  is  desirable.  They  should  never  be  kept  on  the' same 
shelf  with  any  other  medicine.  The  top  shelf  is  the  best  place, 
for  two  reasons :  it  requires  an  effort  to  get  at  them,  and  they  are 
out  of  the  reach  of  children. 

(3)  Never  take  a  medicine  in  the  dark,  however  sure  you  may 
be  that  you  know  what  is  in  the  bottle.    There  is  always  the 
possibility  of  a  mistake,  or  some  one  may  have  changed  the  bottle 
for  another. 

(4)  Never  use  an  unmarked  medicine,  either  liquid  or  powder. 
If  the  label  is  lost,  throw  away  the  contents  of  the  bottle  or  package. 
Many  powders  have  practically  the  same  appearance.     Epsom 
salts  and  oxalic  acid  are  easily  mistaken  for  each  other. 

(5)  Look  at  the  label  three  times :  first,  when  the  bottle  is  taken 
from  the  shelf ;  second,  as  the  medicine  is  poured  out ;  third,  when 
the  bottle  is  returned  to  the  shelf.     It  is  possible  for  the  eye  to 
fail  one  so  that  the  wrong  bottle  is  picked  up  in  a  hurry.     Pour 
out  the  medicine  with  the  label  up,  so  that  while  you  are  measuring 
you  unconsciously  see  the  name.    Then,  as  you  return  the  bottle 
to  the  shelf,  again  read  the  label.     With  care  such  as  this  there  is 
little  chance  that  a  mistake  will  be  made. 

(6)  Measure  carefully  and  exactly.     If  the  doctor  has  ordered 
a  certain  quantity  of  medicine,  that  is  the  dose  he  intends  to  be 
given,  not  a  drop  more  or  less.    If  the  liquid  is  allowed  to  run  over 
the  edge  of  the  spoon,  it  may  increase  the  dose  from  a  quarter  to  a 
half.    If  a  solution  has  been  prepared  for  a  certain  per  cent  of  a 
grain  to  a  teaspoonful,  one  may  easily  give  double  the  amount.     A 
graduated  glass,  or,  if  drops  are  to  be  given,  a  pipette,  will  make 
the  measurement  exact.     Every  household  should  have  a  measuring 
glass  in  the  medicine  closet.    A  teaspoonful  is  a  very  uncertain 
measurement,  both  because  the  size  of  the  spoon  may  vary,  and 
also  because  medicines  measure  varying  quantities  to  a  teaspoonful 
according  to  the  viscidity  of  the  liquid.  ,  A  teaspoonful  of  sirup, 
for  example,  is  larger  than  a  teaspoonful  of  water.     If  minims 
are  ordered,  measure  with  a  minim  glass,  as  minims  and  drops 


Personal  Hygiene  and  Home  Nursing 

are  not  always  the  same.  Always  shake  the  bottle,  for  the  sediment 
in  the  bottom  is  often  the  chief  ingredient  in  the  prescription,  and 
if  the  liquid  is  poured  from  the  top  and  later  from  the  bottom 
without  shaking,  the  strength  of  the  medicine  actually  taken  varies 
greatly. 

(7)  Do  not  buy  medicines  in  large  quantities.     In  many  cases 
they  change  with  time.     Some  may  lose  their  strength,  while 
those  prepared  with  alcohol  become  more  concentrated  because 
of  evaporation.     Always  recork  the  bottle  securely  to  prevent 
evaporation. 

(8)  Give  medicines  at  the  hour  ordered.     The  physician  knows 
exactly  how  much  of  the  medicine  he  wants  the  patient  to  get, 
and  how  soon  it  will  be  necessary  to  repeat  the  dose.     If  he  orders 
it  given  every  three  hours,  he  means  three  hours  and  not  three 
hours  and  twenty  minutes.     If  a  doctor  orders,  for  example,  a 
stimulant  every  three  hours,  he  knows  that  at  the  end  of  the  time 
stated  the  patient  will  need  that  medicine.     If  allowed  to  go  with- 
out it  beyond  the  time  prescribed,  the  patient  is  weakened,  and  the 
medicine  has  extra  work  to  do  in  overcoming  the  effect  of  the  delay. 

(9)  If  two  medicines  are  to  be  given,  be  sure  that  they  can  be 
given  at  the  same  time.     Some  drugs  are  not  compatible,  and  we 
should  have  clear  directions  from  the  doctor  as  to  the  possible 
necessity  of  an  interval  between  the  two.     If,  when  they  are  mixed, 
a  deposit  is  formed  or  the  color  changed,  it  is  a  sure  sign  that  the 
two  are  incompatible. 

(10)  Acids  and  irons  should  not  be  allowed  to  touch  the  teeth. 
They  should  be  given  through  a  glass  tube  or  paper  straw  put  well 
back  in  the  mouth,  and  the  mouth  thoroughly  rinsed  afterward. 
If  this  is  done,  there  should  be  no  injury  to  the  teeth. 

(n)  When  medicines  are  given  to  an  unconscious  patient,  all 
powders  and  pills  should  be  dissolved  and  dropped  slowly  and 
gradually,  well  back  into  the  mouth. 

(12)  The  dilution  of  medicines  should  receive  careful  attention. 
Cough  sirups  are  taken  undiluted.  All  irritating  medicines,  such 


Administering  Medicine  191 

as   acids,   arsenics,   and  iron,   should  be  well    diluted.      Saline 
cathartics  are  given  as  saturated  solutions. 

(13)  Make  medicines  as  palatable  as  possible.     A  medicine  in- 
tended to  be  given  hot  should  be  hot,  and  one  meant  to  be  cold 
should  be  cold.     When  possible,  the  taste  of  medicine  should  be 
disguised,    especially    with    children.     Castor    oil    is    practically 
tasteless  if  a  piece  of  ice  is  held  in  the  mouth  before  it  is  taken  and 
the  oil  and  spoon  used  in  giving  it  are  cold.     Another  method  of 
administering  it  so  that  the  taste  is  not  detected  is  by  putting  it  in 
a  glass  of  soda  water  flavored  with  sarsaparilla,  lemon,  or  orangeade. 
In  preparing  castor  oil  with  soda  water,  be  careful  not  to  daub 
oil  on  the  edge  of  the  glass.     Have  the  contents  of  the  glass  cold, 
and  put  in  an  abundance  of  the  flavoring.     Medicines  can  often 
be  given  in  capsules  instead  of  in  powders.     It  is  not  wise  to  give 
medicine  to  children  in  milk  or  food,  as  it  may  make  them  dislike 
the  food  so  that  they  will  refuse  it  later. 

(14)  Medicine  should  not  be  given  with  food  which  lessens  the 
effect  or  has  a  bad  influence.     Calomel,  for  example,  should  not  be 
given  with  milk  or  eggs,  or  with  salt  food.     lodids  should  not  be 
given  with  starchy  food.     If  the  doctor  does  not  give  directions 
on  this  point,  make  sure  by  asking  him. 

(15)  When  a  medicine  is  to  be  continued  for  a  long  tune,  under- 
stand the  adverse  symptoms  which  may  be  expected  from  its  use. 
It  is  not  necessary  to  tell  these  to  the  patient,  who  might  through 
nervousness    imagine    or    exaggerate    the    sensations    produced. 
Many  medicines  are  cumulative  in  their  effects ;    that  is,  as  they 
are  given  day  after  day,  the  effect  upon  the  system  becomes  greater 
and  greater  until  poisoning  may  result.     Examples  of  this  are 
found  in  medicines  containing  strychnin  and  arsenic.     Ask  the 
doctor  to  explain  exactly  the  symptoms  which  will  indicate  the 
time  for  stopping  the  medicine  or,  on  the  other  hand,  the  necessity 
of  reporting  to  him. 

(16)  It  is  a  good  plan  to  fasten  on  the  door  of  the  medicine 
closet,  with  thumb  tacks,  a  list  of  the  medicines  to  be  found  in  it, 


1 92          Personal  Hygiene  and  Home  Nursing 

and  whatever  simple  directions  may  be  needed  by  any  one  needing 
medicines  in  a  hurry.  The  medicine  closet  should  be  kept  in 
scrupulous  order,  with  the  bottles  all  in  their  own  places  and  set 
so  that  the  labels,  so  far  as  possible,  can  be  easily  seen.  The 
closet  should  be  placed  where  a  light  can  easily  be  thrown  into  it. 
Another  wise  plan  in  some  households  would  be  to  keep  in  the 
closet,  or  fastened  to  the  door,  a  list  of  simple  remedies  which  are 
not  medicines. 

(17)  When  a  patient  is  extremely  ill,  medicines,  particularly 
stimulants,  should  be  given  as  regularly  through  the  night  as 
through  the  day.  As  the  patient  becomes  convalescent,  the  night 
doses  may  be  omitted ;  but  it  is  best  for  the  amateur  nurse  to  have 
the  permission  of  the  physician  before  omitting  a  stimulant.  A 
patient  is  of  course  not  awakened  for  a  sleeping  medicine. 

Taking  patent  medicines.  There  are -few  greater  evils  in  the 
world  than  that  of  taking  patent  medicines.  There  are  laws  in  the 
United  States  which  control  the  sale  of  these  medicines  and  require 
the  manufacturers  of  those  containing  poisonous  or  injurious  drugs 
to  print  upon  the  labels  the  contents  of  the  bottle ;  but  there  are 
so  many  ways  of  evading  the  law  or  of  making  the  labels  confusing 
that  many  persons  take  these  medicines,  knowing  little  of  the 
contents  and  nothing  of  their  effect.  The  safest  plan  is  not  to  take 
patent  medicines  at  all. 

One  serious  consequence  which  may  follow  the  taking  of  patent 
medicines  is  the  forming  of  a  drug  habit.  Much  has  been  written 
on  the  danger  of  forming  habits  by  the  taking  of  morphin  or 
other  forms  of  opium,  cocain,  or  other  well-known  drugs ;  but  few 
realize  that  habits  can  be  formed  by  taking  other  medicines  besides 
these.  One  of  the  worst  cases  of  medicine  habits  I  have  ever  known 
was  one  of  trional,  a  medicine  which  is  given  freely  by  physicians 
and  taken  freely  by  the  laity.  Other  drugs,  such  as  phenacetin, 
aspirin,  strychnin,  veronal,  calomel,  and  coca-cola,  are  taken  too 
freely  by  many  who  know  nothing  of  their  effects  upon  the  sys- 
tem or  of ^  the  danger  of  forming  a  habit  by  their  use. 


Administering  Medicine  193 

Taking  medicine  for  insomnia.  Most  of  the  drug  habits  are 
formed  in  trying  to  break  up  insomnia.  There  are  so  many  simple 
ways  of  helping  to  bring  on  sleep  that  all  other  means  should 
be  tried  before  resorting  to  medicines,  and  these  should  never  be 
taken  except  under  the  advice  of  a  physician.  Frequently  the 
physician  can  relieve  even  long-standing  cases  of  insomnia  by 
simple  means.  Sometimes  the  trouble  is  in  the  digestion ;  some- 
times it  is  caused  by  nervous  strain,  overwork,  or  lack  of  exercise 
or  fresh  air. 

Many  persons  exaggerate  the  amount  of  sleep  they  lose.  If  they 
would  stop  and  calculate  the  number  of  hours  they  sleep,  though 
apparently  awake  half  the  night,  they  would  often  find  that  they 
had  slept  almost  as  much  as  the  ordinary  person,  though  appar- 
ently awake  much  of  the  night.  There  is  perhaps  a  wakeful 
time  in  the  middle  of  the  night,  but  they  sleep  when  first  in  bed 
and  in  the  morning,  and  really  get  almost  as  much  sleep  as  they 
need.  The  dread  of  insomnia  is  more  a  matter  of  nervousness 
than  anything  else,  and  we  really  exaggerate  to  a  large  extent  its 
real  effects. 

Taking  another's  prescriptions.  Never  take  another  person's 
prescription,  for,  although  you  may  be  sure  that  you  know  the 
effects  of  the  medicines  included  in  it,  there  may  be  something  in 
your  physical  condition  (for  instance,  in  the  condition  of  your  heart 
or  kidneys)  of  which  you  do  not  know,  which  may  cause  a  medicine 
that  has  been  prescribed  for  some  one  else  to  be  injurious  to  you. 
Never  buy  medicines  from  a  drug  store  and  take  them  without 
knowing  the  contents.  Most  headache  medicines  and  medicines 
for  colds  contain  derivatives  of  coal  tar.  All  of  these  are  very 
depressing  to  the  heart,  and  many  cases  of  heart  failure  have 
followed  the  taking  of  headache  medicines.  Medicines  for  colds 
contain  also  camphor  and  other  drugs,  which,  taken  freely,  may 
cause  convulsions  or  other  complications. 


CHAPTER   TWENTY-SIX 

COMMON  EMERGENCIES 

THE  greatest  test  of  a  nurse,  trained  or  untrained,  is  her  ability 
to  meet  the  unexpected ;  and  the  very  first  thing  she  must  re- 
member is  to  keep  cool,  to  be  quiet  and  apparently  deliberate  in 
her  movements.  If  you  have  ever  seen  a  good  nurse  meet  an 
emergency,  you  may,  perhaps,  have  wondered  how  it  was  possible 
for  her  to  be  so  little  excited  when  all  around  were  rushing  about 
and  asking  questions,  and  you  may  have  even  felt  irritated  with 
her  for  the  little  interest  and  sympathy  which  she  seemed  to  be 
showing.  But  yet  it  was  she  who  relieved  the  patient  and  "quieted 
the  friends,  and  it  was  because  of  her  calmness  that  she  was  able 
to  think  quickly  and  do  that  which  needed  to  be  done. 

Unconsciousness.  Unconsciousness  is  one  emergency  that 
frequently  has  to  be  met,  and  it  is  best  to  be  somewhat  sure  of 
the  nature  of  the  attack  before  giving  a  treatment. 

Sudden  unconsciousness  may  mean  fainting,  apoplexy,  poison, 
intoxication,  convulsion,  hysteria,  or  an  epileptic  attack.  In- 
toxication may  be  detected  by  the  breath,  and  one  should  be  sure 
not  to  mistake  a  case  of  apoplexy  for  one  of  intoxication,  for  the 
result  of  such  a  mistake  may  be  serious.  If  there  are  no  symptoms 
of  poisoning,  follow  this  general  rule :  If  the  patient  is  pale  and 
weak,  lay  him  down  flat  or  with  head  lower  than  the  rest  of  the 
body ;  if  the  face  is  red  and  the  pulse  full,  place  a  pillow  under  the 
head  and  apply  ice  or  cloths  wet  in  cold  water  to  the  head,  and  do 
not  give  a  stimulant. 

Fainting.  Fainting  is  caused  by  a  diminished  amount  of  blood 
in  the  brain.  It  may  be  due  to  fright,  a  shock,  or  anything  strongly 
affecting  the  nervous  system,  or  it  may  be  caused  by  weakness 
from  hunger  or  overexertion.  Some  persons  faint  easily,  at  the 
sight  of  blood,  from  nausea,  or  from  the  close  air  of  a  crowded 
room,  and  in  some  this  tendency  is  constitutional.  In  such  cases 
no  very  great  alarm  need  be  felt,  as  the  consequences  of  the  faint- 
ing fit  are  not  serious.  Hysteria  sometimes  produces  a  successful 

194 


Common  Emergencies  195 

imitation  of  fainting,  although  it  is  ,a  great  mistake  to  assume 
that  one  can  always  control  a  faint  feeling  by  the  will.  In  a  true 
faint  there  are  unconsciousness,  paleness,  relaxed  muscles,  and  a 
weak  and  rapid  pulse.  In  hysteria  there  is  not  unconsciousness, 
the  face  may  be  flushed,  the  pulse  is  not  weak,  and  if  you  try  to 
lift  the  eyelids  they  will  resist. 

An  approaching  fainting  fit  may  sometimes  be  warded  off  by 
leaning  over  and  putting  the  head  down,  or  lying  down,  so  that 
the  blood  may  return  to  the  brain.  The  patient  should  lie  flat, 
with  the  head  as  low  as  the  body,  or  lower.  The  clothing,  especially 
at  the  throat,  should  be  loosened,  and  people  should  not  be  al- 
lowed to  crowd  around.  Cold  air  or  cold  water  on  the  face  and 
rubbing  the  hands,  arms,  and  legs  help  to  restore  circulation. 
Smelling  salts  and  ammonia  may  be  put  to  the  nose,  but  this 
must  be  done  carefully  so  that  the  nose  and  throat  will  not  be 
irritated.  The  patient  should  remain  perfectly  quiet  and  receive 
a  stimulant  as  soon  as  possible. 

Hysteria  and  its  treatment.  To  be  subject  to  attacks  of  hysteria 
is  very  distressing,  and  while  there  are  women  who  work  them- 
selves into  this  condition  to  attract  attention,  physicians  now 
recognize  that  tendency  to  hysteria  may  be  a  real  disease  and  a 
most  distressing  one.  There  is  often  a  physical  cause  for  such 
attacks.  One  should  be  patient  and  kind  in  dealing  with  a  nervous 
person,  but  at  the  same  time  firm  and  unyielding,  and  it  is  some- 
times best  to  ignore  the  attack  entirely.  Fresh,  cold  air  on  the 
face,  a  dose  of  aromatic  spirits  of  ammonia,  or  a  drink  of  cold 
water  may  aid  the  patient  to  regain  self-control.  Holding  the 
patient's  hand,  or  pressing  her  arm  quietly  and  firmly,  may  also 
be  a  help.  Never  argue  with  such  a  patient,  but  be  quiet  and 
controlled  and  thus  make  her  feel  your  strength  and  desire  to  help 
her. 

Hysterical  patients  are  sometimes  cured  by  providing  them 
with  some  real  interest  which  enlists  their  attention,  either  tem- 
porarily or  permanently.  They  should  be  led  to  think  of  some- 


196          Personal  Hygiene  and  Home  Nursing 

thing  besides  themselves  and  not  to  dwell  upon  their  own  sensa- 
tions. Hysterical  patients  have  been  known  to  simulate  success- 
fully nearly  every  known  disease,  sometimes  with  such  accuracy 
as  to  deceive  physicians.  On  the  other  hand,  the  nervous  system 
may  be  really  affected  in  some  obscure  way  which  presents  the 
appearance  of  hysteria.  In  either  case  the  first  necessity  is  firm 
and  quiet  strength  in  the  nurse  and  wholesome  conditions  and 
occupations  to  restore  the  patient's  vitality. 

Shock.  An  injury,  severe  or  slight,  may  be  followed  by  the 
condition  known  as  shock.  I  have  seen  children  in  this  condition 
after  a  slight  fall  when  they  were  practically  uninjured.  It  is 
often  spoken,  of  as  •"  collapse,"  and  the  symptoms  are  somewhat 
like  those  of  collapse  in  disease. 

In  a  condition  of  shock,  the  face  is  drawn  and  pinched,  the 
skin  cold,  the  pulse  very  weak,  sometimes  not  to  be  felt  at  all  at 
the  wrist,  and  the  patient  is  often  unconscious.  With  children 
there  may  be  vomiting. 

The  treatment  is  to  stimulate  with  heat,  and  unless  there  is 
unconsciousness,  to  give  stimulants  such  as  aromatic  spirits  of  am- 
monia, one  half  to  one  teaspoonful  in  one  fourth  to  one  half  glass 
of  water.  If  there  is  unconsciousness,  an  enema  of  coffee  may 
be  given.  Rub  the  arms  and  legs  to  improve  the  circulation,  but 
keep  the  patient  as  quiet  as  possible  and  do  not  uncover  him.  In 
an  emergency  hospital,  beds  with  warm,  thick  blankets  to  be  placed 
next  to  the  patient  are  kept  ready  for  accident  cases,  and  as  soon 
as  it  is  known  that  a  patient  is  coming,  hot-water  bags  are  put  into 
the  bed  so  that  it  will  be  warm. 

Convulsions.  Children  are  more  subject  to  convulsions  than 
are  adults.  Indigestion,  teething,  constipation,  and  other  slight 
ailments  may  be  accompanied  by  convulsions,  because  the  nervous 
system  is  affected.  Convulsions  sometimes  come  at  the  beginning  of 
a  contagious  disease.  The  first  symptom  of  a  convulsion  is  likely 
to  be  a  twitching  of  the  muscles  of  the  hands  and  face,  and  rolling 
of  the  eyes.  In  a  convulsion  of  this  nature  the  child  then  becomes 


Cqjnmon  Emergencies  197 

unconscious  and  its  body  stiffens.  The  pulse  is  weak,  the  respira- 
tion rapid,  and  the  skin  wet  and  clammy. 

The  quickest  remedy  is  a  hot  bath,  or,  better  still,  a  hot  mustard 
bath.  Be  careful  in  preparing  the  bath  not  to  have  the  water  too 
hot.  It  should  be  no°F.  If  you  do  not  have  a  thermometer, 
hold  the  elbow  in  the  water  long  enough  to  be  sure  the  temperature 
is  not  too  high.  The  proportion  of  mustard  to  use  in  a  mustard 
bath  is  one  tablespoonf  ul  to  about  a  gallon  of  water.  If  the  mustard 
is  first  mixed  with  a  small  quantity  of  cold  water,  it  will  dissolve 
more  easily,  and  this  in  the  end  saves  time.  The  hot  water  should 
begin  to  act  with  quieting  effect  in  a  few  minutes,  but  the  bath 
may  be  continued  for  from  ten  to  twenty  minutes,  adding  hot 
water  gradually  to  keep  the  temperature  even.  If  there  has  been 
constipation,  it  is  well  to  wash  out  the  bowels  to  relieve  the  pressure 
there.  If  this  is  done  at  once  when  the  restlessness  and  twitching 
of  the  muscles  are  observed,  an  attack  is  sometimes  warded  off. 
The  child  often  goes  to  sleep  just  after  the  attack,  and  there  should 
be  perfect  quiet,  as  a  sudden  noise  may  cause  a  return  of  the  con- 
vulsion. 

Convulsions  in  an  adult.  Aside  from  hysteria,  the  two  causes 
that  predispose  to  convulsions  in  an  adult  are  epilepsy  and  uremic 
poisoning. 

In  an  epileptic  fit  the  patient  falls  down  suddenly,  giving  a 
sharp  cry;  his  body  twitches  violently  and  he  sometimes  foams 
at  the  mouth.  The  fit  lasts  only  a  few  minutes,  and  nothing  need 
be  done  except  to  loosen  the  clothing,  move  away  anything  which 
may  cause  him  to  hurt  himself,  and  put  something  between  the 
teeth  to  prevent  biting  the  tongue.  The  best  thing  for  this  pur- 
pose is  a  wad  or  roll  of  muslin,  such  as  a  large  handkerchief.  In 
putting  it  in  the  mouth  be  careful  not  to  get  your  fingers  between 
the  teeth.  After  the  attack  the  patient  becomes  conscious,  and 
will  often  sleep  for  some  time. 

Uremic  convulsions  indicate  diseased  kidneys,  and  are  caused 
by  the  retention  in  the  system  of  the  waste  products  which  are 


198          Personal  Hygiene  and  Home  Nursing 

eliminated  by  the  kidneys  when  in  a  healthy  condition.  The 
convulsion  is  severe,  and  is  followed  by  unconsciousness.  The 
patient  should  be  put  to  bed,  covered  well,  and  kept  warm  with 
hot-water  bags  around  her ;  and  as  this  is  a  dangerous  condition, 
a  doctor  should  be  called  at  once.  There  are  often  premonitory 
symptoms  before  an  attack  of  this  kind.  When  nursing  a  case 
of  Bright's  disease,  watch  for  these  symptoms  and  if  possible 
ward  off  the  attack.  The  indications  of  its  approach  are  head- 
ache, vomiting,  and  drowsiness,  and  they  can  sometimes  be  re- 
lieved by  giving  hot  packs  or  steam  baths.  It  is  best  to  have 
clear  directions  from  the  doctor  so  that  you  will  know  exactly 
what  to  do  in  such  an  emergency. 

Sunstroke.  Extreme  heat  either  in  the  sun  or  in  the  house  may 
cause  sunstroke.  Heat  accompanied  by  moisture  is  most  likely 
to  cause  it.  Rider  Haggard  records  the  case  of  a  woman  who  had 
lived  without  injury  for  years  in  India,  but  who  had  a  sunstroke 
on  a  farm  in  Norfolk.  In  certain  tropical  climates,  such  as  Porto 
Rico,  where  there  is  little  moisture  in  the  air  during  the  hot  season, 
sunstroke  is  unknown. 

The  symptoms  of  sunstroke  are  unconsciousness,  dry  and  hot 
skin,  flushed  face,  a  slow,  full  pulse,  and  labored  breathing. 

Remove  the  patient  to  a  cool  place,  apply  cold  wet  cloths  or 
ice  to  the  head  and  face,  and  if  possible  immerse  the  patient  in  a 
cold  bath  or  use  a  cold  pack.  When  the  patient  is  conscious,  give 
cold  water  to  drink,  but  do  not  use  stimulants. 

Heat  exhaustion.  Heat  exhaustion  is  caused  by  the  same  con- 
ditions as  sunstroke,  but  the  symptoms  and  treatment  are  quite 
different.  There  is  great  weakness  but  no  unconsciousness,  the 
face  is  pale  and  wet  with  perspiration,  the  pulse  weak  and  rapid, 
and  the  breathing  shallow. 

Remove  the  patient  to  a  cool  place  and  loosen  the  clothing,  but 
do  not  apply  cold  externally.  Give  cool  water  in  moderation,  arid 
such  stimulants  as  tea,  coffee,  or  one  half  to  one  teaspoonful  of  aro- 
matic spirits  of  ammonia  in  one  fourth  to  one  half  glass  of  water. 


Common  Emergencies  199 

Concussion  of  the  brain.  A  fall  or  heavy  blow  on  the  head  is 
sometimes  followed  by  concussion  of  the  brain.  The  patient  lies 
motionless,  apparently  in  a  heavy  sleep,  and  if  aroused  falls  back 
into  the  same  condition.  Treatment  consists  of  laying  the  patient 
on  the  back  with  the  head  slightly  raised,  and  applying  a  hot- water 
bag  to  the  feet  if  they  are  cold.  Hot  drinks  may  be  given,  but  not 
alcohol  in  any  form;  and  there  should  be  absolute  quiet.  This 
unconsciousness  may  last  for  hours  without  bad  results,  but  a 
physician  should  be  catted,  as  there  is  always  the  possibility  that 
there  may  be  a  fracture  of  the  skull  or  more  injury  to  the  brain 
than  appears  at  first.  Sometimes  in  such  cases  a  blood  clot  forms 
on  the  brain  and  only  quick  work  by  a  'surgeon  can  prevent  serious 
consequences. 

Gas  poisoning.  In  unconsciousness  due  to  poisoning  from 
illuminating  gas  there  is  no  difficulty  in  recognizing  the  cause,  as 
the  gas  will  fill  the  room  where  the  patient  is  found.  Carry  the 
patient  into  the  fresh  air,  loosen  the  clothing,  and  give  artificial 
respiration,  at  the  same  time  rubbing  briskly  on  the  bare  skin. 
Clean  the  mouth  out,  pull  out  the  tongue,  and  hold  ammonia  to 
the  nostrils,  being  careful  not  to  choke  the  patient  with  the  fumes. 
When  consciousness  returns,  give  a  stimulant,  wrap  a  blanket 
around  the  patient,  and  if  necessary  apply  heat.  If  there  is  not 
unconsciousness,  the  patient  may  be  taken  into  the  fresh  air, 
walked  up  and  down,  and  given  small  doses  of  aromatic  ammonia 
at  intervals  of  twenty  minutes  or  half  an  hour. 

Recently  there  have  been  many  cases  of  poisoning  in  automobile 
garages  by  carbon  monoxid,  the  dangerous  constituent  of  illuminat- 
ing gas.  This  gas  is  formed  by  the  incomplete  combustion  of  the 
gasoline  in  the  cylinders  of  the  engine.  It  gives  no  warning  of  its 
presence,  as  it  is  odorless  and  tasteless.  To  avoid  danger  from  it, 
a  gasoline  engine  should  not  be  run  in  an  inclosed  room  unless  an 
exhaust  is  provided  for  the  waste  gases.  Any  one  overcome  in  a 
garage  should  receive  the  same  treatment  that  is  given  for  poison- 
ing with  illuminating  gas. 


2Oo          Personal  Hygiene  and  Home  Nursing 


FIG.  63.     Draining  the  water  from  the  lungs. 


Restoration  of  those  res- 
cued from  drowning.  As 
soon  as  a  person  is  drawn 
out  of  the  water,  the  clothes 
should  be  loosened  and  she 
should  be  turned  face  down- 
ward with  the  head  low,  to 
allow  the  water  to  run  out 
of  the  lungs.  If  laid  over  a 
barrel  or  log,  or  over  a  pile 
of  sand,  lumber,  or  clothes, 
the  body  can  be  elevated 
while  the '  head  is  low.  If 
nothing  of  this  kind  is  near 
by,  the  patient  can  be  lifted 
by  placing  the  hands  under 
the  abdomen  or  she  can  be 
laid  over  the  knee  of  one  of 


the  rescuers.  Clean  out  the  mouth  and  throat,  remove  false 
teeth  if  there  are  any,  and  grasp  the  tongue  to  prevent  it  from 
falling  back  into  the  throat ;  if  necessary  it  can  be  tied  with  a 
cloth,  or  if  a  long  pin  is  thrust  through  the  tongue  the  pin  will 
rest  against  the  teeth  and  keep  the  tongue  out.  Give  artificial 
respiration  and  go  on  with  it  for  hours,  even  if  there  is  no 
apparent  sign  of  life.  Apply  heat  to  the  body  and  rub  the  arms 
and  legs.  When  consciousness  returns,  so  that  the  patient  can 
swallow,  give  hot  drinks  such  as  hot  coffee,  tea,  lemonade, 
ammonia,  or  even  hot  water. 

Artificial  respiration.  There  are  several  methods  of  giving 
artificial  respiration,  but  whatever  method  is  used,  certain  pro- 
cedures are  the  same :  the  mouth  must  be  held  open  and  a  small 
object  like  a  folded  handkerchief  should  be  put  between  the  teeth ; 
the  tongue  should  be  pulled  well  out  of  the  mouth ;  and  all  move- 
ments of  artificial  breathing  should  be  given  at  about  the  rate 


Common  Emergencies 


201 


FIG.  64.  How  the  tongue  can  be  fas- 
tened to  pievent  its  falling  back  into  the 
throat. 


of  rather  slow  breathing  (fifteen 
to  eighteen  movements  to  the 
minute) . 

The  Schafer  method,  devised 
by  Professor  Schafer  of  Scotland, 
is  most  often  used  now.  It  is 
used  in  the  English  army,  and 
has  been  recommended  by  the 
American  Medical  Association 
as  simple  and  effectual.  In  this 
the  patient  is  laid  chest  down- 
ward, with  his  head  low  and  his 
face  turned  to  one  side.  The 
operator  kneels  at  the  side  of 

the  patient,  or  places  himself  astride  of  him,  with  his  face  toward 
the  patient's  head.  The  operator's  hands  are  placed  on  each 
side  of  the  patient's  back  just  over  the  muscles  of  the  small 
of  the  back,  and  the  spread  fingers  over  the  lower  ribs.  Then 
he  sways  his  body  slowly  forward,  pressing  down  with  his  hands 
on  the  body  of  the  patient.  After  holding  this  position  for 
about  two  seconds  he  sways  backward,  releasing  the  body  from 
pressure  but  not  removing  his  hands.  In  this  way  the  air  is 
pushed  out  of  and  drawn  into  the  lungs  of  the  patient.  The 
treatment  should  be  given  at  the  rate  of  about  fifteen  movements 
to  the  minute  and  should  be  continued  until  the  patient  breathes 
well  —  if  necessary,  for  two  or  three  hours.  It  should  be  begun 
at  the  earliest  possible  moment  after  the  person  is  taken  out  of 
the  water,  as  the  important  thing  is  to  get  oxygen  into  the  blood 
at  once. 

The  Sylvester  method  is  not  often  used  now  after  drowning,  but 
is  convenient  for  use  if  breathing  stops  during  an  operation,  when, 
of  course,  it  may  not  be  possible  to  turn  the  patient  on  his  face. 
It  is  the  same  in  the  beginning  as  all  other  methods:  the  clothing 
is  loosened,  the  mouth  opened,  the  tongue  is  pulled  out  and  tied, 


202          Personal  Hygiene  and  Home  Nursing 


•• 

*  .  . . 


FIG.  65.  The  Schafer  method  of  artificial  respiration.  The  oper- 
ator's hands  are  placed  on  each  side  of  the  patient's  back,  with  the 
fingers  spread  over  the  lower  ribs. 

and  the  body  rolled  over  some  object  that  will  place  the  head  low 
enough  for  the  water  to  drain  from  the  lungs.  After  the  water 
has  stopped  running  from  the  lungs  the  patient  is  laid  on  his  back, 
and  a  roll  of  clothing  or  something  of  the  kind  put  under  his  neck 
so  that  his  head  will  fall  backward.  Kneeling  at  the  patient's 
head,  grasp  the  forearms  just  below  the  elbows  and  fold  his  arms 
down  across  the  lower  ribs.  Then  raise  the  arms  up  over  his  head, 
and  bring  them  down  again  to  his  sides,  making  pressure  again 
over  the  ribs.  Continue  slowly  raising  and  lowering  the  arms, 
pressing  upon  and  opening  out  the  lungs  with  a  bellowslike  move- 
ment until  natural  breathing  begins  again.  After  the  patient  is 
breathing,  wrap  him  in  a  warm  blanket,  rub  his  arms  and  legs  to 
restore  circulation,  apply  heat  if  necessary,  and  give  him  aromatic 
spirits  of  ammonia,  well  diluted. 

The  method  which  I  have  found  most  practicable  in  giving  arti- 
ficial respiration  to  infants  is  the  following:  Take  the  infant, 
back  down,  in  the  two  hands,  the  left  hand  supporting  the  shoulders 
and  head,  with  the  little  finger  under  the  left  arm,  the  thumb  under 


Common  Emergencies 


203 


FIG.  66.  After  pressing  downward  on  the  body  of  the  patient  for 
about  two  seconds,  the  pressure  is  released  but  the  hands  are  not 
removed. 

the  right  arm,  and  the  other  fingers  under  the  head.  With  the 
right  hand  support  the  buttocks  and  legs.  Bring  the  two  hands 
toward  each  other,  doubling  the  infant  in  the  middle  of  its  body, 
then  separate  the  hands  until  the  infant's  body  is  slightly  curved 
backward  (Fig.  69,  page  206).  As  in  other  methods,  the  mouth 
must  first  be  cleansed  of  all  foreign  matter  and  the  tongue  held 
well  out  of  the  mouth,  and  the  movements  should  not  be  given 
too  rapidly. 

Croup.  An  attack  of  croup  is  alarming  but  seldom  dangerous. 
It  begins  with  a  loud  cough ;  the  face  becomes  blue,  and  the  child 
struggles  for  breath.  Hot  cloths  around  the  throat  often  give 
relief.  It  is  well  to  give  an  emetic,  and  if  the  child  is  subject  to 
these  attacks  a  bottle  of  sirup  of  ipecac  should  be  kept  in  the  house. 
The  dose  is  one  teaspoonful.  Croup  kettles  are  found  efficacious 
in  many  cases.  Allowing  the  child  to  breathe  in  steam  from  an 
inhaler  or  a  pitcher  of  hot  water  helps  to  loosen  the  phlegm,  but 
care  must  be  taken  to  prevent  a  burn. 


204          Personal  Hygiene  and  Home  Nursing 


FIG.  67.    The  Sylvester  method  of  artificial  respiration.    Raise  the 
arms  over  the  patient's  head. 

Colic  or  cramps.  Colic  is  caused  by  an  accumulation  of  gas  in 
the  intestines,  usually  from  undigested  food,  but  sometimes  from 
a  sudden  chill  or  an  obstinate  attack  of  constipation.  A  mild 
attack  may  be  relieved  by  drinking  hot  water  with  or  without  a 
little  soda,  by  soda  mint  tablets,  by  a  few  drops  of  peppermint, 
or  by  an  application  of  heat. 

Clearing  out  the  bowels  with  an  enema  followed  by  a  quick 
cathartic  will  give  more  permanent  relief.  The  attack  may  be  so 
severe  as  to  be  dangerous,  and  in  such  a  case  a  doctor  should  be 
sent  for  at  once.  Cloths  may  be  wrung  out  of  hot  water  and 
put  on  the  abdomen.  It  is  best  to  wash  out  the  bowels  instead 
of  giving  an  enema,  not  injecting  too  much  water  at  a  time ;  apply 
heat  to  the  feet  and  keep  the  patient  well  covered,  as  there  is  often 
shock  in  these  cases.  A  long  rectal  tube  should  be  used  in  giving 
the  injection,  but  if  one  is  not  at  hand,  use  a  short  nozzle.  In 
the  meantime  send  for  a  rectal  tube  and  repeat  the  treatment  if 
the  first  one  has  not  given  relief. 

Vomiting.  When  vomiting  is  due  to  indigestion,  it  is  best  not 
to  check  it  until  the  stomach  is  empty.  Drinking  a  glass  of  luke- 


Common  Emergencies 


205 


FIG.  68.    Then  bring  them  down  again,  making  pressure  over  the  ribs. 

warm  water  will  help  to  clear  out  the  stomach.  If  the  paroxysm 
is  very  severe  and  there  are  signs  of  exhaustion,  or  if  an  operation 
is  followed  by  vomiting  from  nervousness,  it  is  best  to  check  it. 
This  may  be  done  by  applying  a  mustard  plaster  or  mustard 
leaves  over  the  stomach,  bathing  the  face  and  throat  in  cold  water, 
feeding  small  pieces  of  ice,  laying  cloths  wrung  out  of  ice  water 
around  the  throat,  or  giving  salts  or  vinegar  to  smell.  Sometimes 
persistent  vomiting  can  be  stopped  by  turning  the  patient  face 
downward,  with  a  doubled-up  pillow  under  the  abdomen,  the  head 
low  and  the  body  on  an  incline. 

Hiccoughs.  A  hiccough  is  a  spasmodic  contraction  of  the 
diaphragm  —  the  muscular  partition  lying  between  the  chest 
cavity  and  the  abdomen.  It  is  caused  by  indigestion,  or  by  over- 
eating or  overdrinking.  Taking  a  deep  breath  and  holding  it 
sometimes  gives  relief.  A  sudden  fright  or  startling  noise,  drink- 
ing a  glass  of  water  while  holding  the  breath,  or  lying  on  the  face 
in  the  position  used  to  check  vomiting,  also  may  give  relief. 
It  is  best  to  stop  hiccoughs  immediately  on  their  appearance  if 
possible,  as  the  longer  the  attack  continues  the  more  obstinate  it 
is  likely  to  be. 


206          Personal  Hygiene. and  Home  Nursing 


Retention  of  urine.     WJien  the  urine  is  secreted  by  the  kidneys 
but  not  passed  from  the  bladder,  the  condition  is  called  retention 


FIG.  69.    Administering  artificial  respiration  to  an  infant. 

of  urine.  This  may  occur  after  an  operation,  or  when  the  patient 
suffers  from  shock.  In  young  girls  and  boys  it  is  a  form  of  nervous- 
ness or  hysteria,  sometimes  caused  by  retaining  the  urine  for  a 
long  time  without  the  opportunity  of  passing  it.  Sometimes  it 
is  caused  by  difficulty  in  using  a  bed  pan.  Heat  applied  over  the 
bladder  by  means  of  hot  cloths  or  hot-water  bags  will  sometimes 
start  the  flow.  Hot  water  in  the  pan  or  vessel  to  be  used,  or  run- 
ning water  from  the  faucet  or  from  one  pitcher  to  another,  may 
help.  Pouring  warm  water  over  the  pubic  region,  or  a  hot  hip 
bath,  may  give  relief.  If  these  remedies  fail,  it  may  be  necessary 
to  draw  the  urine  with  a  catheter,  but  this  should  never  be  done 
except  by  a  doctor  or  nurse.  If  it  is  not  properly  done,  there  is 
danger  of  causing  irritation  of  the  entrance  into  the  bladder  or  of 
carrying  infection  into  the  bladder  itself. 

Food  poisoning.  Food  poisoning,  often  called  ptomain  poison- 
ing, is  caused  by  eating  foods  infected  with  certain  kinds  of  bacteria. 
Meat  and  vegetables  that  have  been  canned  without  thorough 
sterilization  may  be  infected  with  the  germ.  As  cooking  destroys 
the  toxin  from  the  germs,  the  danger  from  ptomain  poisoning  is 
much  less  if  all  canned  goods  are  cooked  before  using. 


.  Common  Emergencies  207 

The  symptoms  of  food  poisoning  are  violent  nausea,  severe  pain 
in  the  abdomen,  and  acute  diarrhea.  There  is  frequently  great 
prostration  and  weakness ;  therefore  we  must  guard  against  these, 
stimulating  and  keeping  the  patient  warm.  Castor  oil  or  Epsom 
salts  can  be  given  to  hasten  the  expulsion  of  the  poison  from  the 
intestine.  It  is  best  to  call  a  doctor  promptly,  so  that  more  severe 
remedies  may  be  promptly  used  if  necessary. 

Unless  we  are  sure  of  the  cause  of  the  attack,  the  patient  should 
be  examined  for  symptoms  of  appendicitis ;  and  the  earlier  in  the 
attack  the  doctor  is  called,  the  more  favorable  the  prognosis. 


CHAPTER  TWENTY-SEVEN 
WHAT  TO  DO  IN  CASE  OF  POISONING 

IN  no  cases  of  emergency  work  is  there  a  greater  need  of  know- 
ing what  to  do  than  in  poisoning.  It  is  impossible  for  any  one  to 
remember  exactly  the  antidotes  for  all  poisons ;  but  with  a  general 
knowledge  of  the  first  steps  to  be  taken,  much  can  be  done  to  re- 
lieve the  patient  before  the  coming  of  the  physician.  Where  a 
physician  is  hard  to  reach,  a  "  First  Aid  to  the  Injured  "  book, 
containing  suggestions  for  antidotes,  should  be  kept  at  hand  and 
the  nurse  should  be  able  to  begin  her  work  without  delay. 

When  to  suspect  poisoning  and  what  to  do.  In  cases  of  sudden 
illness  or  unconsciousness,  we  should  suspect  poison.  As  a  rule, 
a  suicide  tells  what  he  has  done  as  soon  as  the  medicine  begins  to 
affect  him.  If  the  patient  is  a  child,  or  the  medicine  has  been 
taken  by  accident,  the  bottle  or  box  may  usually  be  found  and  so 
we  can  learn  what  poison  has  been  taken. 

A  doctor  should  be  summoned  immediately  and  told  why  he  is 
needed,  and  if  you  have  been  able  to  discover  the  nature  of  the 
poison  he  should  be  told  this  also.  The  poisons  most  frequently 
taken  are  opium  preparations,  carbolic  acid,  bichlorid  of  mercury, 
and  arsenic. 

Do  not  wait  for  the  doctor's  arrival,  but  begin  treatment  at  once, 
(i)  Rid  the  system  of  the  poison.  (2)  Neutralize  the  effects  with 
an  antidote.  (3)  Stimulate  the  patient.  (4)  Soothe  the  digestive 
organs. 

Emetics.  The  stomach  should  be  cleared  of  the  poison  either 
by  an  emetic  or  by  some  mechanical  means  for  causing  vomiting, 
such  as  sticking  the  finger  down  the  throat  and  tickling  the  back 
of  the  throat.  Emetics  easy  to  obtain  are  mustard  water  (one 
teaspoonful  of  mustard  to  a  cupful  of  water),  soda  in  water  (two 
tablespoonfuls  of  baking  soda  to  a  quart  of  water),  salt  and  water, 
or  merely  a  large  quantity  of  warm  water.  These  emetics  are 
more  effective  if  given  warm  than  if  they  are  either  cold  or  hot. 
Ipecac  is  a  simple  emetic  which  it  is  well  to  keep  in  the  house; 

208 


What  to  Do  in  Case  of  Poisoning  209 

the  dose  is  one  to  two  drams.  Apomorphin,  a  drug  which  is 
an  emetic,  is  given  hypodermically.  It  is  always  carried  in  the 
physician's  and  nurse's  medicine  cases* 

When  not  to  use  emetics.  In  the  case  of  poisons  like  strong 
acids  or  alkalies,  or  other  poisons  which  injure  the  mucous  mem- 
branes, emetics  should  not  be  used.  Instead  give  milk,  raw  eggs, 
boiled  starch,  flour  and  water,  barley  water,  or  mashed  potatoes, 
which  are  soothing  to  the  mouth  and  stomach  and  help  to  prevent 
the  absorption  of  the  poison.  Oil  is  not  always  to  be  used,  as  it 
quickens  the  absorption  of  some  poisons. 

Antidotes.  An  antidote  is  something  that  counteracts  the  effect 
of  a  poison.  For  instance,  the  antidote  for  an  alkali  is  an  acid, 
such  as  lemon  juice  or  vinegar.  To  counteract  acids,  give  lime- 
water,  baking  soda,  plaster,  or  tooth  powder.  After  the  antidote 
give  an  emetic,  unless  the  nature  of  the  poison  makes  the  use  of 
an  emetic  unadvisable. 

Bichlorid  of  mercury  poisoning.  This  preparation  of  mercury 
is  used  a  great  deal  in  disinfecting.  For  this  reason  it  is  easy  to 
obtain.  The  death  following  bichlorid  of  mercury  is  exceedingly 
painful,  as  it  is  frequently  slow  in  its  effect,  stopping  the  secretion 
of  urine  in  the  kidneys  and  causing  great  agony.  The  symptoms 
of  mercury  poisoning  are  white  and  swelled  mucous  membrane, 
pain  in  the  abdomen,  nausea  with  vomiting,  and  bloody  move- 
ments from  the  bowels.  The  skin  is  cold  and  clammy  and  the 
patient  much  prostrated  and  frequently  in  convulsions.  The 
treatment  is  first  to  give  white  of  egg  or  flour  and  water  and  sooth- 
ing liquids,  such  as  milk.  Emetics  should  then  be  given.  Treat 
poisoning  by  calomel  and  blue  mass  like  bichlorid  poisoning. 

Opium  poisoning.     Among  the  common  opium  preparations  are : 

Laudanum  or  tincture  of  opium,  dose  four  to  ten  drops. 

Dover  powders,  dose  eight  to  ten  grains. 

Paregoric,  dose  one  to  four  drams  (teaspoonful). 

Heroin,  dose  one  half  to  one  tenth  of  a  grain. 

Morphin,  dose  one  sixteenth  to  one  fourth  of  a  grain. 


210          Personal  Hygiene  and  Home  Nursing 

Morphin  is  an  active  principle  of  opium.  The  passing  of  the 
Harrison  law  makes  it  much  harder  to  obtain  morphin  and  is 
materially  decreasing  the  mimber  of  cases  of  morphin  poisoning. 
Heroin  is  a  compound  made  from  morphin  and  is  a  dangerous 
habit-forming  drug.  Opium  is  found,  too,  in  many  patent  medi- 
cines the  sale  of  which  has  been  stopped  by  the  Harrison  law. 

The  symptoms  of  opium  poisoning  are  drowsiness,  unconscious- 
ness, pulse  fast  and  then  .weak,  breathing  very  slow  and  shallow, 
face  flushed  (almost  purple).  The  pupils  of  the  eyes  are  contracted 
and  do  not  dilate  when  exposed  to  the  light. 

The  treatment  consists  of  an  emetic,  followed  by  a  stimulant, 
preferably  coffee,  which  not  only  helps  the  heart  action  but  aids 
in  keeping  the  patient  awake.  Do  not  allow  the  patient  to  go  to 
sleep ;  if  necessary,  walk  him  up  and  down  persistently,  slap  him, 
use  any  means  to  keep  him  awake,  but  be  careful  not  to  exhaust 
his  strength.  If  the  breathing  becomes  too  shallow,  give  artificial 
respiration  (page  200)  as  long  as  the  acute  symptoms  are  present. 
Vomiting  should  be  continued  to  keep  the  stomach  empty,  as 
opium  is  absorbed  from  the  stomach  and  returned  to  it  even 
when  taken  by  hypodermic.  The  patient  should  be  kept  warm, 
as  the  temperature  is  likely  to  be  low. 

Carbolic  acid  poisoning.  The  common  use  of  carbolic  acid  or 
phenol  in  disinfecting  makes  it  easy  to  obtain.  Thus  it  is  one  of 
the  most  common  poisons  used  by  suicides.  It  is  easy  to  detect, 
as  the  odor  is  noticeable  and  the  mucous  membrane  of  the  mouth 
and  throat  are  burned.  The  treatment  begins  with  the  rinsing 
of  the  mouth  with  alcohol  and  giving  alcohol  internally,  using 
either  brandy  or  whisky,  one  tablespoonful  of  pure  alcohol  (not 
wood  alcohol),  or  wines.  The  antidote  is  Epsom  salts,  one  to  two 
or  three  tablespoonfuls.  Limewater  and  milk  in  equal  parts,  flax- 
seed  tea,  or  raw  eggs  may  be  given ;  neither  oil  nor  glycerin  should 
be  given,  as  they  quicken  absorption  of  the  acid.  Urine  should  be 
passed  if  possible;  the  patient  should  be  kept  warm  and  stimu- 
lants used  if  necessary. 


What  to  Do  in  Case  of  Poisoning  211 

Creolin,  lysol,  and  DobelFs  solution  are  compounds  made  from 
carbolic  acid,  and  the  symptoms  and  treatment  are  the  same  as  in 
carbolic  acid  poisoning.  Creosote  is  another  of  these  compounds, 
but  it  is  seldom  taken  in  poisonous  doses. 

Arsenic  poisoning.     The  preparations  of  arsenic  are : 
Fowler's  solution,  dose  three  to  five  drops. 
Donovan's  solution,  dose  three  to  five  drops. 

Arsenic  is  also  found  in  salvarsan,  Paris  green,  and  rat  and  ver- 
min poisons. 

The  symptoms  of  arsenic  poisoning  are  pain  in  the  stomach  and 
abdomen,  vomiting,  intense  thirst,  bloody  movements  from  the 
bowels,  rapid,  weak  pulse,  clammy  skin,  and  sometimes  uncon- 
sciousness. 

The  treatment  begins  with  an  emetic  if  there  has  been  no  vomit- 
ing. Then  give  milk,  white  of  egg,  or  flaxseed  tea.  If  the  bowels 
have  not  moved,  give  castor  oil.  Watch  the  urine,  as  its  secretion 
is  sometimes  lessened  or  stopped. 

Strychnin.  The  preparations  of  strychnin,  which  is  the  active 
principle  of  nux  vomica,  are : 

Tincture  of  nux  vomica,  dose  ten  to  twenty  drops. 

Strychnin  sulfate,  dose  one  sixtieth  to  one  twentieth  of  a  grain. 

Sirup  of  iron,  quinin,  and  strychnin,  dose  one  to  two  drams. 

The  symptoms  of  strychnin  poisoning  are  restless  excitement 
followed  by  convulsions,  in  which  the  legs  become  rigid,  the  arms 
bent,  the  hands  clenched,  the  eyes  open  and  staring,  and  the 
mouth  fixed  in  a  characteristic  grin.  After  the  convulsion  the 
body  relaxes,  but  the  slightest  touch  or  noise  will  cause  another 
attack. 

The  treatment  consists  of  an  emetic,  strong  tea  for  the  tannic 
acid  contained  in  it,  and  charcoal.  The  patient  should  be  kept 
perfectly  quiet.  The  bladder  must  be  kept  empty,  as  the  drug 
will  be  reabsorbed  from  the  urine  if  this  is  not  done. 

Phosphorus.     The  preparations  of  phosphorus  are : 

Sirup  of  hypophosphates,  dose  one  to  two  teaspoonfuls. 


212          Personal  Hygiene  and  Home  Nursing 

Hypophosphate  of  iron,  potassium  sodium,  and  calcium;  dose 
ten  grains. 

Phosphorus  is  found  also  in  matches,  rat  poison,  and  vermin 
powders  and  pastes. 

The  symptoms  of  phosphorus  poisoning  are  severe  pain  in  the 
stomach,  and  vomiting  of  material  which  is  luminous  in  the  dark. 
There  may  be  fever,  bleeding  from  the  nose,  or  convulsions. 

Give  an  emetic  and  clean  out  the  bowels  with  Epsom  salts,  one 
half  ounce  in  a  tumbler  of  water,  or  magnesia ;  soothe  the  diges- 
tive organs  with  liquids  such  as  milk  or  flour  paste.  Use  no  oils, 
fats,  or  stimulants. 

Aconite.  Tincture  of  aconite  contains  this  drug;  dose,  three 
minims. 

The  symptoms  are  irregular  pulse;  slow,  shallow,  and  weak 
respiration ;  anxious  expression  with  eyes  glaring,  dilated,  and  pro- 
tuberant ;  sometimes  convulsions. 

Give  an  emetic,  also  strong  tea;  apply  heat;  give  artificial 
respiration  if  necessary  and  keep  the  patient  quiet,  with  the  head 
low. 

Alcohol.  The  symptoms  of  alcohol  poisoning  are  excitement 
followed  by  coma,  irregular  and  stertorous  respiration,  flushed 
face,  pulse  rapid  and  hard,  and  breath  smelling  of  alcohol. 

Apply  heat  to  the  feet,  cold  to  the  head,  and  guard  against 
heart  failure.  For  stimulants  give  hot  coffee  or  aromatic  spirits 
of  ammonia,  one  teaspoonful  in  a  half  glass  of  water. 

Atropin.  This  is  contained  in  atropin  sulfate;  dose  one 
sixtieth  of  a  grain. 

The  symptoms  are  dryness  of  the  throat,  difficult  breathing, 
dilated  pupils,  flushed  face,  restlessness,  delirium,  and  sometimes 
convulsions. 

Give  an  emetic  of  warm  water ;  stimulate  if  necessary  and  give 
artificial  respiration.  The  bladder  should  be  emptied  frequently, 
as  the  medicine  reabsorbs.  Apply  external  heat,  perhaps  a  mus- 
tard bath,  and  put  hot  and  cold  applications  to  the  head. 


What  to  Do  in  Case  of  Poisoning  213 

Belladonna.  Ointments  and  liniments  often  contain  bella- 
donna, as  do  atropin  and  hyoscyamin. 

The  symptoms  are  dryness  of  the  mouth  and  skin,  a  rash  like 
that  of  scarlet  fever,  dilated  pupils  and  staring  eyes,  headache, 
restlessness,  and  delirium. 

Give  an  emetic  and  a  hot  mustard  bath;  apply  cold  to  the 
head ;  give  artificial  respiration  if  necessary ;  and  watch  the  urine. 

Camphor.  Found  in  spirits  of  camphor,  cough  mixtures,  and 
liniments. 

The  symptoms  are  excitement,  giddiness  and  headache,  pain  in 
the  stomach,  delirium  and  convulsions,  small  weak  pulse  followed 
by  collapse. 

Give  an  emetic,  apply  heat,  and  give  stimulants. 

Chloral.  Somnol  and  chloral  hydrate  contain  this  drug.  The 
dose  is  five  to  twenty  grains  or  fifteen  to  thirty  drops. 

The  symptoms  are  slow  and  shallow  respiration;  pulse  first 
slow,  then  rapid,  weak,  and  thready ;  there  may  be  unconscious- 
ness, with  the  muscles  relaxed. 

Give  an  emetic ;  use  alcohol  and  hot  coffee  as  stimulants ;  give 
a  mustard  foot  bath ;  apply  heat  and  treat  with  electricity.  Be 
careful  not  to  exhaust  the  patient. 

Chloroform.  The  symptoms  are  irregular  pulse  and  respira- 
tion ;  the  latter  may  at  times  stop ;  the  pupils  are  dilated. 

Give  artificial  respiration,  putting  the  feet  higher  than  the 
head;  stimulate,  apply  heat,  and  watch  to  see  whether  urine  is 
suppressed. 

Cocain.  The  symptoms  are  nervousness,  irritability,  wakeful- 
ness,  nausea,  vomiting,  and  convulsions.  The  skin  is  pale;  the 
pulse  rapid  at  first,  but  later  slow  and  weak.  Respiration  is  first 
quick  and  then  slow  and  labored. 

The  treatment  is  to  empty  the  stomach,  apply  heat,  and  give 
stimulants. 

Digitalis.  Infusion,  dose  one  to  two  drams ;  tincture,  dose  five 
to  twenty  drops ;  fluid  extract,  two  to  four  drops. 


214          Personal  Hygiene  and  Home  Nursing 

The  symptoms  are :  pulse  slow,  irregular,  and  weak ;  headache, 
paleness,  eyes  prominent,  respiration  rapid,  with  great  prostration, 
possibly  convulsions. 

Give  tepid  water  as  an  emetic.  The  antidote  is  strong  tea,  for 
the  tannin  contained  in  it.  Give  strychnin  as  a  stimulant,  and 
keep  the  patient  quiet  and  lying  down. 

Hyoscyamus.  This  drug  is  found  in :  fluid  extract,  dose  one 
to  three  minims ;  tincture,  dose  ten  to  twenty  minims ;  and 
hyoscin  hydrobromid,  dose  one  hundredth  to  one  fiftieth  of  a 
gram. 

The  symptoms  are  thirst,  dilated  pupils,  and  unconsciousness  or 
delirium. 

Give  an  emetic  and  hot  baths ;  apply  cold  to  the  head ;  and  if 
necessary  give  artificial  respiration.  Watch  the  urine. 

lodin.  The  preparations  of  iodin  are  potassium  iodid,  dose  five 
to  thirty  drops,  and  tincture  of  iodin  for  external  use. 

The  symptoms  are  pain  and  burning  in  the  stomach  and  abdo- 
men, vomitiijg  and  purging,  and  dark  stains  in  the  mouth  and  on 
the  lips. 

First  give  a  paste  of  water  mixed  with  flour  or  starch,  then  give 
an  emetic,  and  apply  heat.  Stimulate  if  necessary. 

Lead.  Lead  is  found  in  sugar  of  lead,  dose  one  half  to  two 
grains. 

The  symptoms  of  poisoning  are  dry  throat,  a  metallic  taste  and 
thirst,  colic,  cramp  in  the  legs,  sometimes  convulsions,  and  a  dark 
line  on  the  gums. 

The  treatment  is  white  of  egg  and  one  or  two  or  three  table- 
spoonfuls  of  Epsom  salts  or  magnesia,  an  emetic,  soothing  drinks, 
stimulants,  and  application  of  heat. 

Mushroom  poisoning.  The  symptoms  may  appear  immediately 
or  not  until  hours  after  the  mushrooms  have  been  eaten.  Nausea, 
vomiting,  colic,  diarrhea,  weak  pulse,  labored  breathing,  and  pro- 
fuse perspiration  are  the  earlier  symptoms.  Later  there  may  be 
muscular  weakness,  collapse,  and  sometimes  paralysis. 


What  to  Do  in  Case  of  Poisoning  215 

The  treatment  consists  of  emetics,  large  doses  of  castor  oil,  heat 
applied  all  over  the  body,  and  stimulants. 

Oxalic  acid.  This  is  found  in  the  form  of  oxalic  acid  crystals 
which  may  easily  be  mistaken  for  Epsom  salts.  It  is  used  for  re- 
moving stains. 

The  symptoms  are  burning  of  the  mucous  membrane,  abdominal 
pain,  cold  livid  skin,  irregular  pulse,  stupor,  collapse,  and  some- 
times convulsions. 

Give  oil,  milk,  white  of  egg.  The  antidote  is  chalk  or  lime. 
Give  stimulants  and  apply  external  heat. 

Potash.  The  common  preparations  of  potash  are :  chlorate  of 
potash,  dose  ten  to  thirty  grains ;  cyanid  of  potassium,  one  tenth 
to  one  twelfth  of  a  grain;  cream  of  tartar  (potassium  bitartrate), 
dose  10  to  60  grains;  saltpeter,  dose  two  to  ten  grains;  caustic 
potash,  used  only  externally. 

The  symptoms  of  potash  poisoning  are  acute  inflammation  in 
the  alimentary  canal,  pain,  nausea,  vomiting  and  loose  dysenteric 
stools,  a  weak  rapid  pulse,  shrunken  face,  cold  skin,  and  uncon- 
sciousness. Death  may  occur  with  great  suddenness. 

The  general  antidotes  are  dilute  vinegar,  lemon  juice,  or  cider. 
Give  also  oil,  barley  water,  flaxseed  tea,  milk,  white  of  egg,  or 
gruel,  to  allay  the  irritation  of  the  mucous  membrane  and  keep  up 
the  strength. 

Chlorate  of  potash  is  particularly  dangerous  to  children  and 
should  not  be  used  by  them  as  a  gargle.  The  acute  symptoms  of 
poisoning  by  this  preparation  are :  vomiting,  diarrhea,  breathless- 
ness,  cyanosis  (blue  discoloration  of  the  skin),  urine  dark  and 
diminished  in  quantity  or  perhaps  suppressed.  Subacute  symp- 
toms are  headache,  loss  of  appetite,  and  pains  in  the  abdomen  and 
other  parts  of  the  body. 

Cases  of  poisoning  by  cream  of  tartar  are  rare,  but  have  been 
known,  when  a  tablespoonful  or  more  has  been  taken.  The  symp- 
toms are  stomach  and  intestinal  troubles. 

Saltpeter  poisoning    causes   burning  pain    in  the    throat  and 


2i6          Personal  Hygiene  and  Home  Nursing 

stomach,  bloody  movements  from  the  bowels,  fainting,  collapse, 
and  sometimes  convulsions. 

Cyanid  of  potassium  poisoning  is  indicated  by  giddiness,  faint- 
ness,  difficult  breathing,  a  weak  small  pulse,  insensibility,  and  loss 
of  muscular  power.  The  eyes  are  protruding  and  shining,  and 
there  is  an  odor  of  acid  on  the  breath. 

There  is  but  little  time  for  treatment.  The  antidote  is  a  weak 
solution  of  sulfate  of  iron.  Cold  water  should  be  applied  to  the 
head  and  spine.  Give  artificial  respiration,  and  go  on  with  it  as 
long  as  there  is  any  sign  of  breathing.  Give  inhalations  of  am- 
monia and  stimulate  with  alcohol. 

Caustic  potash  poisoning  is  indicated  by  corrosive  burns  upon 
the  lips  or  mouth,  bleeding  and  sloughing  of  the  mucous  mem- 
brane, and  vomiting  of  shreds  of  membrane  and  blood. 

Prussic  acid  (hydrocyanic  acid).  The  symptoms  of  poisoning 
and  the  treatment  are  the  same  as  for  poisoning  by  cyanid  of  potas- 
sium, and  like  the  latter,  prussic  acid  acts  very  quickly.  A  strong 
odor  of  peaches  may  be  detected  where  this  acid  has  been  spilled. 

Wood  alcohol  (methyl  alcohol,  wood  naphtha).  The  symptoms 
are  headache,  nausea,  violent  vomiting,  collapse,  and  possibly 
convulsions.  The  pupils  are  dilated,  and  there  are  profuse  per- 
spiration and  great  excitement. 

Give  an  emetic,  apply  heat,  and  stimulate. 

Some  dangerous  poisons  are  used  in  photographic  work,  and 
care  should  be  taken  to  keep  them  out  of  the  way  of  children. 
Poisonous  fly  paper  or  fly  poison  should  not  be  used  where  children 
can  get  at  them.  Paint  is  often  poisonous,  and  some  people  are 
upset  merely  by  the  smell  of  it  if  much  painting  is  going  on.  Some 
cleaning  preparations  are  poisonous.  There  are  people  who  have 
the  dangerously  careless  habit  of  using  old  bottles  without  remov- 
ing the  original  labels.  This  should  never  be  done.  A  rule  in  every 
household  should  be  that  nothing  whatever  in  the  way  of  a  drug, 
medicine,  powder,  or  extract  should  ever  be  left  unlabeled.  It  is 
better  to  take  a  little  extra  trouble  than  to  risk  death  by  poison. 


CHAPTER   TWENTY-EIGHT 
COMMON  INJURIES 

THE  importance  of  understanding  the  treatment  of  common 
injuries  lies  in  two  facts:  (i)  Such  injuries  often  demand  imme- 
diate attention  in  a  place  where  no  doctor  can  be  had ;  and  (2)  the 
consequences  of  a  neglected  injury,  even  though  it  may  appear 
to  be  a  slight  one,  are  often  serious.  Even  when  no  disastrous 
results  are  to  be  feared,  the  discomfort  and  annoyance  of  a  small 
injury  may  be  very  considerable,  and  it  is  well  worth  while  to 
study  how  to  avoid  them.  In  most  cases  no  medicine  is  needed, 
and  an  intelligent  amateur  may  be  of  great  service  in  caring  for 
the  injury.  It  is  important  also  to  know  when  to  call  the  doctor, 
and  when  the  injury  is  really  a  slight  one,  especially  with  such 
injuries  as  burns  or  scalds. 

Burns  and  scalds.  A  burn  is  an  injury  made  by  dry  heat,  while 
a  scald  is  one  inflicted  by  steam,  hot  water,  or  oil.  Burns  and 
scalds  are  divided  into  three  classes  according  to  the  degree  of 
injury : 

(1)  Burns  which  merely  redden  the  skin.     In  a  burn  of  this 
kind  there  is  no  danger  unless  a  large  part  of  the  body  is  injured, 
but  it  is  quite  painful.    Plunge  the  burned  part  immediately  into 
cold  water ;  then  dress  it  with  a  saturated  solution  of  bicarbonate 
of  soda  (cooking  soda)  or  cover  it  with  olive  oil  (sweet  oil),  cream, 
lard,  vaselin,  butter,  or  almost  any  oil,  or  with  flour  or  starch. 

(2)  Burns  deep  enough  to  blister.    The  treatment  for  a  burn 
of  this  kind  is  the  same  as  that  given  above,  except  that  the  blister 
must  be  opened.    To  do  this,  snip  it  at  one  edge  with  a  sharp  pair 
of  scissors,  or  press  gently  on  the  blister  with  a  piece  of  absorbent 
cotton  and  catch  the  escaping  fluid  in  a  second  piece  of  cotton, 
not  letting  the  fluid  come  in  contact  with  the  skin.     Do  not  re- 
move the  skin,  as  it  acts  as  a  protection.     Be  careful  not  to  make 
the  bandage  too  tight. 

(3)  Severe  burns  that  injure  the  deeper  tissues.     If  the  burn 
is  deep  or  the  extent  of  surface  burned  is  considerable,  a  physician 

217 


2i 8          Personal  Hygiene  and  Home  Nursing 

should  be  called  at  once.  Remove  the  clothes  and  put  oil  on  the 
burn.  Never  use  a  powder  on  a  burn  of  this  class,  as  it  cakes 
.  and  is  hard  to  remove.  Cover  with  soft  muslin  and  do  not  put 
on  the  bandage  too  tight.  Guard  against  shock.  A  burn  of  this 
kind  is  cleansed  and  washed  with  a  disinfectant  solution  and 
dressed  with  olive  oil,  vaselin,  or  carron  oil.  This  last  is  a  mix- 
ture of  oil  and  limewater,  which  is  kept  prepared  at  all  drug 
stores.  The  seriousness  of  a  burn  depends  mainly  upon  the  ex- 
tent of  surface  burned.  If  one  half  of  the  body  or  more  is 
burned,  recovery  is  nearly  impossible. 

Treating  burns  with  paraffin.  A  change  in  the  method  of  treat- 
ing burns  has  been  brought  about  by  the  great  war.  Before  the 
war  the  method  of  treating  them  with  paraffin,  first  used  in  France 
by  Dr.  Barthe  de  Sandfort,  had  been  used  by  a  few  physicians 
in  this  country,  but  had  not  been  generally  practiced.  It  has  been 
used  in  France  in  hundreds  of  cases  since  the  beginning  of  the  war, 
and  has  given  wonderful  results,  the  burn,  even  when  extensive 
and  deep,  healing  quickly  and  with  little  pain  to. the  patient.  A 
burn  healed  by  this  method  leaves  practically  no  scars  or  deformity, 
and  skin  grafting  has  been  almost  entirely  abandoned.  It  has 
also  been  useful  in  treating  wounds  where  a  large  amount  of  skin 
has  been  removed. 

The  exact  ingredients  in  the  preparations  of  paraffin  used  are 
not  generally  known,  but  they  are  believed  to  be  paraffin  95  per 
cent,  and  either  beeswax  or  a  vegetable  wax  and  resin.  They  are 
sold  in  small  cakes  which  are  easily  handled  and  which  melt  at  a 
rather  low  degree  of  heat. 

Several  preparations  of  paraffin  are  made  in  this  country,  and 
all,  perhaps,  are  equally  good.  Among  them  are : 

Parresine,  made  in  the  Abbott  Laboratories,  Chicago  and  New 
York. 

Paraffin  No.  7,  made  at  the  Germantown  Hospital,  Phila- 
delphia. 

Amberine,  also  made  in  Philadelphia. 


Common  Injuries  219 

Preparing  the  burn  for  paraffin  dressing.  No  oil,  flour,  or  grease 
should  be  applied  to  a  burn  upon  which  paraffin  dressing  is  to  be 
put.  It  is  necessary  to  have  the  surface  of  the  wound  clean  be- 
fore the  dressing  is  applied,  and  it  is  difficult  to  clean  oil  or  powder 
from  a  wound.  Keeping  the  burn  under  water  will  relieve  pain 
until  the  dressing  can  be  put  on. 

The  surface  of  the  burn  must  be  cleaned,  and  if  necessary  must 
be  washed  with  green  soap,  boric  acid,  or  salt  solution.  While 
doing  this,  care  must  be  taken  not  to  infect  the  wound,  not  to 
injure  the  raw  surface,  and  not  to  wipe  off  any  small  particles  of 
healthy  skin  which  may  have  escaped  burning.  It  must  then  be 
thoroughly  dried.  This  is  most  easily  done  with  an  electric  hair 
drier.  If  this  is  unavailable,  the  surface  may  be  dried  with  folds 
of  warm  gauze  or  filter  paper  and  fanned  with  a  clean  towel 
or  fan. 

Preparing  and  applying  the  paraffin.  The  paraffin  must  be 
melted;  this  is  best  done  in  a  double  boiler.  Great  care  must 
be  taken  to  keep  water  from  getting  into  the  fluid,  as  this  wrater 
will  burn  when  the  paraffin  is  applied.  It  must  be  brought  to  a 
temperature  of  from  140°  to  150°  F.,  and  sprayed  over  the  wound 
with  an  atomizer.  The  atomizer  should  be  heated  before  the 
fluid  is  put  into  it,  and  kept  at  an  even  temperature.  Atomizers 
for  this  purpose  are  made,  which  are  like  double  boilers  with  a 
second  receptacle  for  water.  If  one  of  these  is  not  available, 
an  ordinary  atomizer  may  be  used.  This  can  be  heated  by  im- 
mersing it  in  hot  water,  care  being  taken  not  to  break  it ;  or  the 
paraffin  can  be  painted  on  with  a  camel's-hair  brush  (rubberset). 
When  using  a  brush,  the  greatest  care  must  be  taken  not  to  injure 
the  surface  of  the  wound  or  to  give  pain.  The  fluid  paraffin  should 
be  dabbed  on,  not  brushed,  and  it  should  not  only  cover  the  wound, 
but  extend  slightly  beyond  it  on  the  unburned  skin. 

Cotton  and  gauze  dressing.  After  the  first  layer  of  paraffin 
has  become  hard,  it  must  be  covered  with  a  thin  layer  of  absorbent 
cotton,  and  over  this  a  second  coating  of  the  fluid  should  be  sprayed. 


220          Personal  Hygiene  and  Home  Nursing 

After  this  coat  is  set,  a  gauze  dressing  is  put  on,  and  all  is  held  in 
place  by  a  gauze  bandage. 

Re-dressing  the  burn.  Burns  dressed  with  paraffin  should  be 
re-dressed  at  least  once  in  the  first  twenty-four  hours,  and  later 
at  intervals  of  two  or  three  days.  To  remove  the  dressing,  cut 
through  the  paraffin  outside  of  the  wound,  and  press  or  roll  the 
edges  back,  when  the  part  over  the  wound  is  easily  removed. 

Effects  of  a  paraffin  dressing.  With  this  dressing  the  burn  is 
protected  from  the  air,  the  new  skin  is  protected  against  injury, 
the  hardened  wax,  acting  as  a  splint,  keeps  the  injured  part  in 
position  and  thus  prevents  deformity,  and  the  heat  from  the  ap- 
plication brings  the  blood  to  the  surface  of  the  wound  and  in- 
creases the  flow  of  lymph.  Pain  is  relieved  as  soon  as  the  dressing 
is  applied  and  the  growth  of  new  skin  is  stimulated.  Recovery 
takes  place  in  a  much  shorter  time  when  this  •  treatment  is  used, 
and  more  extensive  burns  are  cured  by  it  than  by  former  methods. 

Rescuing  from  fire.  If  your  own  clothing  or  that  of  any  one 
else  catches  fire,  the  quickest  way  to  put  the  fire  out  is  to  roll 
the  endangered  person  on  the  floor,  wrapped  if  possible  in  a  rug, 
blanket,  woolen  cloth,  or  overcoat,  to  smother  the  flame.  The 
person  coming  to  the  rescue  should  not  come  too  close  if  wearing 
a  thin  gown,  but  if  possible  should  secure  some  heavy  article  to 
wrap  the  sufferer  in. 

In  this  as  in  many  other  cases  prevention  is  easier  than  cure 
and  much  better.  Cheap  celluloid  articles  should  never  be  brought 
near  an  open  flame,  as  they  may  explode.  Cotton-flannel  bath 
robes  or  jackets  should  not  be  worn  near  a  fire  or  a  gas  flame, 
as  a  flame  started  among  the  fibers  on  the  surface  will  very  quickly 
run  over  the  gown.  Light  dresses  should  not  be  worn  very  near 
an  open  fireplace  where  a  sudden  draft  may  sweep  them  into  the 
flames.  Inflammable  fluids  or  materials  should  never  be  used 
where  there  is  an  open  flame  of  any  kind,  and  preferably  not  used 
at  all  in  the  evening.  If  a  gasoline  stove  causes  a  fire,  do  not  try 
to  put  it  out  with  water,  as  the  gasoline  will  rise  to  the  top  of 


Common  Injuries  221 

the  water  and  spread  the  fire ;  use  flour  or  smother  the  flame  with 
a  blanket. 

Live  wires.  To  rescue  any  one  who  is  in  contact  with  a  live 
wire,  it  is  necessary  to  use  certain  measures  for  self-protection. 

(1)  Do  not  touch  the  wire  with  the  hand.     It  may  be  touched 
with  a  dry  stick. 

(2)  Do  not   touch   the  person  before  insulating  yourself  by 
covering  your  hands  with  a  rubber  coat.    If  the  ground  upon  which 
you  are  standing  and  the  person's  clothing  are  dry,  it  is  safe  to 
catch  hold  of  him  by  his  clothes ;   but  in  doing  so  grasp  only  the 
clothing  and  do  not  touch  the  person  himself.     Covering  the 
hand  with  a  piece  of  dry  paper  is  a  protection. 

The  treatment  for  electric  shock  consists  of  loosening  the  clothes, 
giving  artificial  respiration,  and  as  soon  as  possible  giving  a  stim- 
ulant. The  treatment  for  lightning  shock  is  the  same  as  for  in- 
jury by  an  electric  current. 

Freezing.  Freezing  is  a  very  gradual  process.  If  after  feeling 
intense  pain  from  cold,  the  part  becomes  numb  and  pain  is  no 
longer  felt,  there  is  reason  to  suspect  freezing.  Prompt  treatment 
should  .be  given,  rubbing  the  part  briskly  with  snow  or  putting 
it  into  cold  water.  Do  not  come  near  the  fire  or  into  a  warm 
room  for  some  time,  certainly  not  until  sensation  is  fully  restored. 
To  prevent  damage,  the  frozen  tissues  must  be  thawed  out  very 
gradually. 

Snake  bite.  There  are  few  poisonous  snakes  in  this  country, 
and  an  emergency  of  this  kind  is  rare.  When  it  does  occur,  tie  a 
handkerchief  or  strap  above  the  wound  tight  enough  to  stop  the 
circulation.  Open  the  wound  by  using  the  point  of  a  knife,  cut- 
ting lengthwise  of  the  limb,  and  let  it  bleed  freely.  Sucking  the 
wound  will  draw  out  the  poison,  and  is  not  dangerous  unless  the 
skin  of  the  mouth  is  broken.  It  is  not  necessary  to  give  whisky, 
which  is  of  no  benefit  to  the  patient.  The  most  effectual  treatment 
in  these  cases  is  to  use  permanganate  of  potash,  which  can  be 
packed  into  the  wound  after  it  has  been  moistened  with  water. 


222          Personal  Hygiene  and  Home  Nursing 

A  solution  of  this  chemical  is  frequently  injected  with  a  hypodermic 
syringe  around  the  wound  and  is  considered  a  specific  against  the 
poison.  Other  treatments  used  are  to  pack  the  wound  with  soda 
or  to  burn  it  out  with  nitrate  of  silver.  The  patient  should  be 
taken  to  a  physician  as  soon  as  possible. 

Treatment  of  dog  bites.  The  bite  of  a  dog  may  or  may  not 
be  dangerous.  The  wound  should  be  cleansed  at  once  with  bi- 
chlorid  of  mercury,  carbolic  acid,  or  some  other  effective  anti- 
septic, and  ammonia  applied.  If  the  dog  is  sick,  or  if  there  is 
any  reason  to  suspect  hydrophobia,  a  physician  should  see  the 
patient  as  soon  as  possible.  Meantime  the  wound  should  be  kept 
open  and  be  allowed  to  bleed  freely.  To  keep  the  poison  from 
being  taken  up  by  the  blood  into  the  body,  a  tight  bandage  should 
be  applied  between  the  wound  and  the  body,  but  it  should  not 
be  kept  on  longer  than  forty-five  minutes.  If  a  physician  cannot 
be  promptly  reached,  the  wound  should  be  cauterized  with  strong 
carbolic  acid,  nitrate  of  silver,  or  a  hot  iron. 

The  dog  should  not  be  killed  unless  it  is  absolutely  necessary 
to  keep  him  from  biting  other  people,  but  should  be  shut  up  and 
watched  for  symptoms  of  rabies.  If  the  dog  remains  alive,  there 
will  be  no  reason  to  worry.  If  it  develops  rabies,  the  animal 
must  be  killed,  without  injuring  the  brain,  and  the  head  sent  to 
a  laboratory  for  examination.  Many  unfortunate  persons  have 
suffered  indefinitely  from  nervous  apprehension  of  hydrophobia, 
after  having  been  bitten  by  a  dog  not  positively  proved  to  be  mad, 
because  the  dog  was  killed  immediately. 

Hydrophobia.  The  germ  of  hydrophobia  or  rabies  has  not  been 
positively  identified,  but  the  disease  can  be  produced  by  inocula- 
tion with  a  piece  of  the  spinal  cord  or  brain,  or  with  the  saliva  of 
a  diseased  animal.  Sometimes  the  saliva  of  a  dog  is  infectious 
before  symptoms  of  the  disease  appear. 

The  onset  of  rabies  is  gradual,  beginning  frequently  with  pain 
and  congestion  in  the  wound,  mental  depression,  irritability,  and 
increase  in  sensibility  in  the  special  senses.  This  may  be  followed 


Common  Injuries  223 

by  difficulty  in  swallowing,  and  then  convulsions.  There  Is  severe 
pain  in  the  throat,  breathing  becomes  labored,  and  there  may  be 
foaming  at  the  mouth  and  partial  or  complete  paralysis. 

The  prevention  of  the  development  of  this  disease  in  persons 
who  have  been  bitten  by  rabid  animals  is  largely  dependent  upon 
the  extent  of  the  injury  and  the  promptness  with  which  the  Pas- 
teur treatment  is  given.  The  incubation  period  is  never  less  than 
two  weeks  and  may  be  as  long  as  a  year,  and  if  the  Pasteur  treat- 
ment (in  which  the  patient  is  repeatedly  vaccinated  against  the 
germ)  is  begun  in  time,  the  development  of  the  disease  can  almost 
always  be  prevented.  It  may  be  added  that  there  have  been  very 
fair  imitations  of  hydrophobia  due  to  the  nervous  terror  of  the 
disease  and  brooding  over  the  symptoms.  The  best  plan  is  to  do 
everything  possible  to  avert  the  danger  and  then  believe  it  past. 

Nosebleed.  As  a  rule  this  is  unimportant,  but  a  quantity  of 
blood  may  be  lost,  and  it  is  therefore  well  to  check  it.  Do  not 
allow  the  patient  to  lean  over  the  basin,  as  this  will  increase  the 
bleeding.  Put  cold  applications  over  the  nose,  and  little  pieces 
of  ice  well  up  inside  the  nostrils.  A  compress  pushed  up  inside 
the  nose  will  stop  the  bleeding,  or  two  compresses  may  be  used  to 
make  pressure  on  the  outside  of  the  nose.  Strap  them  down  tight 
against  the  sides  of  the  nose  with  adhesive  plaster. 

Foreign  bodies  in  the  eye.  It  is  best  not  to  close  the  eye  when 
a  foreign  body  gets  into  it,  for  if  the  foreign  particle  is  a  sharp 
piece  of  coal  or  a  particle  of  stone  or  plaster,  closing  the  lid  down 
may  force  it  into  the  eyeball.  Syringe  it  out  with  a  medicine 
dropper,  or  try  to  dislodge  the  object  by  washing  the  eye  with  an 
eye  glass  or  by  pouring  a  stream  of  water  over  the  open  eye.  Turn 
the  lid  up  or  pull  it  down,  and  remove  the  particle  with  a  clean 
handkerchief  or  cloth.  Do  not  rub  the  eye  which  has  the  foreign 
body  in  it,  but  rub  the  other  eye. 

Foreign  bodies  in  the  ear.  Sometimes  a  child  will  put  some 
small  object  into  the  ear.  If  it  is  anything  that  may  swell  with 
water,  like  a  bean,  do  not  syringe  it.  If  a  moth  has  entered  the 


224          Personal  Hygiene  and  Home  Nursing 

ear,  holding  a  light  close  to  the  ear  will  cause  it  to  crawl  out.  If 
the  object  is  hard  to  dislodge,  go  to  a  specialist ;  for  an  unskilled 
person  may  easily  damage  the  tympanic  membrane. 

Foreign  bodies  in  the  nose.  Do  not  try  to  dislodge  an  object 
fiom  the  nose  by  poking  an  instrument  up  into  the  nostrils,  as 
this  only  pushes  it  farther  up.  Tickle  the  nose  or  use  a  pinch  of 
pepper  to  cause  sneezing.  Sometimes  the  object  can  be  dislodged 
by  pressing  with  thumb  and  ringer  on  the  outside  of  the  nose, 
beginning  close  up  to  the  eyes  and  pressing  and  stroking  gently 
toward  the  end  of  the  nose.  If  this  does  not  dislodge  the  object, 
take  the  child  to  a  physician.  When  small  children  are  about, 
one  should  never  mention  the  possibility  of  their  putting  beans 
into  their  noses  or  ears,  as  there  seems  to  be  a  fascination  in  the 
idea  and  they  are  very  likely  to  try  it. 

Foreign  bodies  in  the  throat.  Objects  like  bits  of  meat,  coins, 
buttons,  or  even  soft  articles  like  a  piece  of  bread,  may  lodge  in 
the  throat  and  stop  the  entrance  of  air  into  the  trachea.  If  the 
patient  is  a  child,  take  him  by  the  feet,  hold  him  upside  down  and 
shake  him,  or  beat  him  upon  the  back.  A  grown  person  should 
be  thumped  on  the  back,  and  if  this  does  not  bring  relief  he 
should  be  laid  face  down  on  a  couch  with  the  head  hanging  down, 
and  beaten  on  the  back  to  dislodge  the  intruding  object. 

Swallowing  pins  or  coins.  If  a  child  swallows  a  pin,  coin,  or 
other  object,  do  not  give  a  cathartic.  The  cathartic,  by  increas- 
ing the  muscular  activity  of  the  intestines  and  liquefying  their 
contents,  forces  the  object  along  and  gives  it  no  chance  to  be 
covered  by  the  feces.  Soft,  bulky  foods  like  potatoes  or  bread 
may  be  given.  If  the  child  complains  of  pain,  take  him  to  a 
doctor.  Even  a  sharp-pointed  pin  will  as  a  rule  go  through  the 
digestive  tract  without  doing  harm. 

Stings  of  insects.  Apply  ammonia  or  soda  to  insect  stings, 
rubbing  them  well  into  the  wound.  Give  aromatic  spirits  of  am- 
monia in  the  proportion  of  half  a  teaspoonful  to  one  third  of  a  glass 
of  water.  Salt,  wet  earth,  or  cold  water  may  be  used  to  give  relief. 


CHAPTER   TWENTY-NINE 
METHODS   OF  TREATING  WOUNDS 

A  WOUND  is  an  injury  in  which  the  skin  has  been  broken.  Such 
injuries  are  classified  as  cuts  or  incised  wounds,  torn  or  lacerated 
wounds,  and  punctured  wounds.  There  are  two  serious  dangers 
from  wounds:  the  danger  of  loss  of  blood  and  the  danger  of  in- 
fection, of  which  the  latter  is  by  far  the  more  common  and  more 
serious.  Unless  a  wound  is  very  severe  the  bleeding  stops  of  itself 
before  any  great  amount  of  harm  is  done,  but  infection  even  of  a 
most  insignificant  wound  may  cause  a  sore  or  develop  into  tetanus 
(lockjaw).  The  severity  of  a  wound  depends  on  its  extent  and  on 
the  degree  of  hemorrhage  from  it. 

In  using  a  knife  or  any  other  sharp  instrument,  one  should  take 
care  to  have  it  clean  and  not  to  cut  toward  the  hand.  Nails, 
especially  rusty  ones,  should  never  be  left  where  they  may  tear 
the  skin.  Bandages  and  dressings  should  be  kept  in  a  clean  drawer 
by  themselves,  and  if  possible  in  a  sealed  package  or  tight  box, 
so  that  no  dust  can  get  at  them,  and  everything  likely  to  be  needed 
for  dressing  a  cut  should  be  in  one  place  and  in  order.  If  the  knife 
is  clean  and  the  wound  promptly  bandaged,  even  a  severe  cut  will 
usually  heal  easily. 

Small  cuts.  A  small  cut  should  be  allowed  to  bleed  for  a  few 
minutes,  as  this  helps  to  carry  off  dirt  and  bacteria.  Then  sponge 
out  the  wound  with  a  weak  disinfectant,  a  dilute  solution  of  carbolic 
acid,  listerin,  or  alcohol.  Alcohol  stings  for  the  moment,  but  a 
wound  dressed  with  it  heals  quickly.  Wrap  the  injured  part  with 
a  clean  piece  of  gauze  or  old  linen  wet  with  the  disinfectant.  lodin 
is  a  good  disinfectant  and  can  be  painted  right  over  the  wound. 
Peroxid  of  hydrogen  is  little  used  now,  for  although  it  cleans  the 
wound  it  injures  the  tissues  and  delays  the  healing  process.  Unless 
the  opening  is  large  enough  to  allow  it  to  bubble  out  freely,  it  will 
force  the  dirt  into  the  tissue.  If  the  bleeding  is  too  free,  apply 
the  bandage  tightly,  but  when  it  has  stopped,  loosen  the  bandage, 
as  it  is  better  not  to  cut  off  the  blood  supply. 

225 


226          Personal  Hygiene  and  Home  Nursing 

When  far  from  a  doctor,  use  adhesive  plaster  to  close  a  long  cut. 
Put  several  long,  narrow  strips  over  sterilized  gauze,  but  never 
bring  it  in  direct  contact  with  the  wound,  for  it  is  not  free  from 
germs  and  may  result  in  infection.  Collodion  and  "  new  skin  " 
are  prepared  with  ether,  which  is  a  disinfectant,  and  can  be  applied 
directly  to  a  wound. 

Punctured  wounds.  A  punctured  wound  is  one  made  by  a  sharp- 
pointed  instrument  or  a  bullet.  There  is  always  danger  of  infection 
in  such  wounds,  as  the  outlet  is  small  and  the  wound  is  hard  to  clean 
and  drain.  There  is  no  other  serious  danger  unless  the  weapon 
or  bullet  pierces  a  blood  vessel  or  organ. 

If  the  puncture  has  been  made  by  a  stable  fork  or  a  nail,  one 
should  watch  carefully  for  fever  or  symptoms  of  infection,  as 
there  is  always  danger  from  the  tetanus  germ.  A  surgeon 
should  be  called  at  once  to  cleanse  the  wound  and  if  necessary 
administer  and- tetanus  serum  (antitoxin).  This  is  almost  a 
sure  preventive  of  the  disease  if  used  promptly  when  the  injury  is 
sustained. 

Lockjaw  or  tetanus  is  caused  by  a  germ  which  is  most  often 
found  in  soil,  especially  in  manure.  It  develops  most  readily  in  a 
deep  punctured  wound,  and  is  always  carried  into  the  blood  through 
a  wound  of  some  kind.  Wounds  made  by  dirty,  rusty  nails  or 
stable  and  garden  tools  are  especially  likely  to  contain  this  germ. 
A  large  percentage  of  cases  among  children  are  caused  by  wounds 
from  toy  pistols,  fireworks,  and  firecrackers.  It  is  thought  that 
this  is  due  to  the  fact  that  a  wound  from  this  cause  is  deep,  and  that 
dirt  is  carried  in  from  the  skin  of  the  hands.  The  period  of  incuba- 
tion is  usually  from  six  to  fourteen  days,  but  may  vary  from  four 
days  to  three  weeks. 

In  mild  cases  there  is  little  fever,  but  in  severe  cases  the  tem- 
perature may  go  to  from  103°  and  105°  to  110°.  The  muscles  of 
the  head  and  neck  are  the  first  to  be  affected,  gradually  becoming 
rigid.  The  rigidity  then  spreads  over  the  body,  frequently  accom- 
panied by  spasmodic  contractions  of  the  muscles  and  convulsions 


Methods  of  Treating  Wounds  227 

in  which  the  body  is  arched  backward,  until  in  severe  cases  the 
patient  may  rest  upon  his  head  and  heels.  These  convulsions  are 
brought  on  and  intensified  by  a  noise,  a  touch,  or  an  excessive  glare 
of  light.  The  patient  may  die  of  suffocation  because  of  the  rigidity 
of  the  respiratory  muscles. 

If  symptoms  of  the  disease  are  observed,  a  physician  should 
be  called  at  once  and  tetanus  antitoxin  injected.  The  wound 
should  be  opened  well,  allowed  to  bleed,  and  thoroughly  cleansed 
and  drained.  The  patient  should  be  kept  quiet  and  in  a  dark 
room.  Bromids  and  other  quieting  medicines  are  given,  and  to 
check  the  convulsions  chloroform  is  sometimes  used.  Feeding  is 
done  through  the  nose  or  by  enema. 

Lacerated  wounds.  In  a  lacerated  wound  the  tissues  are  torn 
by  a  blow  from  a  blunt  instrument  or  in  some  other  way.  The  chief 
danger  from  such  a  wound  is  that  of  infection.  The  wound  should 
be  carefully  cleansed,  and  the  methods  already  described  used  to 
prevent  infection. 

Hemorrhage  from  wounds.  Hemorrhage  does  not  depend  on  the 
size  of  the  cut,  but  on  the  number  and  size  of  blood  vessels  that 
have  been  injured.  One  of  the  worst  cases  of  collapse  from  hem- 
orrhage that  I  ever  saw  was  that  of  a  man  who  had  a  cut  in  his  scalp 
less  than  an  inch  long.  An  artery  had  been  cut,  and  he  had  been 
brought  from  a  long  distance  to  the  hospital,  without  any  attempt 
having  been  made  to  check  the  bleeding.  There  are  three  kinds 
of  hemorrhage,  and  it  is  most  important  to  be  able  to  recognize 
each  kind.  They  are : 

(1)  Arterial  hemorrhage,  in  which  the  blood  comes  from  a  cut 
artery.     It  may  be  recognized  by  the  blood  coming  in  jets  or 
spurts.    This  is  the  most  dangerous,  because,  owing  to  the  force 
of  the  heart  pumping  it  out,  the  blood  escapes  rapidly. 

(2)  Venous  hemorrhage,   in  which  the  blood  comes  from  a 
vein  and  flows  in  a  slow  but  steady  stream. 

(3)  Capillary  hemorrhage,  which  is  the  oozing  of  blood  from 
the  wound. 


228          Personal  Hygiene  and  Home  Nursing 

How  to  stop  a  hemorrhage.  As  soon  as  bleeding  begins,  Nature 
uses  her  own  method  of  checking  the  flow,  by  forming  a  clot  of  blood 
at  the  end  of  the  cut  blood  vessel.  If  the  bleeding  is  not  too  strong, 
this  is  done.  Our  first  effort,  therefore,  must  be  to  aid  Nature  by 
keeping  the  patient  quiet  and  cutting  off  the  flow  of  blood,  so  that 
the  clot  shall  not  be  dislodged.  The  pressure  must  of  course  be 
upon  the  walls  of  the  blood  vessel  on  the  side  of  the  wound  from 
which  the  flow  is  coming.  In  arterial  hemorrhage  the  blood  is 
coming  from  the  heart,  so  that  pressure  must  be  between  the  cut 
and  the  heart.  In  venous  hemorrhage  the  blood  comes  from  the 
extremities  and  is  returning  to  the  heart ;  therefore  the  pressure 
must  be  on  the  side  of  the  cut  away  from  the  heart.  The  veins 
have  valves  at  intervals  to  prevent  the  flow  of  blood  in  the  wrong 
direction.  The  vein  will,  therefore,  when  pressure  is  applied, 
become  empty  up  to  the  nearest  valve.  In  case  of  a  large  vein 
it  is  well  to  put  compresses  on  the  two  sides  of  the  cut,  or  one  large 
compress  immediately  over  the  cut.  If  the  bleeding  is  from 
capillaries,  a  firm  dressing  or  bandage  is  all  that  is  necessary. 
Cold  water  tends  to  check  the  flow  of  blood ;  warm  water  does  not. 

As  soon  as  hemorrhage  has  been  stopped,  dress  a  severe  wound 
as  you  would  a  small  one,  with  sterile  or  disinfected  gauze,  and 
get  a  doctor  as  soon  as  possible  to  put  in  the  stitches  that  may  be 
needed. 

Internal  hemorrhage.  If  there  is  reason  to  suspect  that  an 
internal  hemorrhage  is  taking  place  in  one  of  the  cavities  of  the 
body,  keep  the  patient  absolutely  quiet,  as  restless  movements 
may  dislodge  the  clot  that  may  be  forming  in  the  end  of  the  broken 
blood  vessel.  Send  for  the  doctor  at  once.  In  case  of  abdominal 
bleeding,  put  an  ice  bag  on  the  abdomen,  raise  the  foot  of  the  bed, 
and  take  away  the  pillow.  The  temperature  will  drop  below 
normal,  and  one  must  guard  against  shock. 

Compresses.  A  compress  is  a  folded  piece  of  cloth  used  to 
create  pressure.  It  is  usually  made  of  gauze,  but  in  an  emergency 
can  be  made  with  a  handkerchief  or  several  handkerchiefs  or  any 


Methods  of  Treating  Wounds  229 

other  soft  material  which  can  be  folded.    A  cork  or  chip  wrapped 
in  a  piece  of  muslin  will  answer. 

The  compress  is  put  over  the  artery  or  veins  and  bandaged 
firmly  in  place.  The  bandage  can  be  tightened  by  slipping  a 
pencil  inside  it  and  twisting  until,  the  compress  is  pressed  against 
the  artery  hard  enough  to  stop  the  bleeding.'  The  blood  flow 
could  be  stopped  as  effectually  by  pressure  with  the  thumb,  but 
such  pressure  could  not  be  kept  up  for  an  indefinite  time,  because 
the  hand  would  become  so  fatigued  as  gradually  to  loosen  its  hold. 

Tourniquets.  A  tourniquet  is  a  strap  used  to  wrap  around  a 
limb  to  stop  bleeding.  In  hospitals  tourniquets  made  of  leather  or 
of  elastic  are  used,  but  in  an  emergency  any  strong  strap  of  any 
material,  a  bandage,  a  handkerchief,  anything  that  can  be  tied 
around  the  part,  will  do.  A  tourniquet  should  be  made  very  tight, 
which  can  be  done  by  twisting  it  close  with  a  stick  or  pencil.  It 
should  not  be  left  on  for  more  than  fifteen  minutes,  as  it  cuts  off 
the  blood  supply  from  the  extremity,  and  may  cause  an  unhealthy 
condition  of  the  part,  or  even  in  some  cases  gangrene.  The  part 
of  the  body  below  a  tight  bandage  or  tourniquet  should  be  kept 
under  observation,  and  if  it  becomes  cold,  swelled,  or  discolored, 
the  bandage  should  be  loosened  and  the  blood  allowed  to  flow  into 
the  extremity.  If,  with  the  removal  of  the  bandage,  the  hem- 
orrhage begins  again,  press  on  the  artery  with  the  finger  until  the 
blood  has  had  a  chance  to  flow  into  the  limb,  and  then  replace 
the  tourniquet.  A  wound  that  bleeds  so  freely  as  to  require  a  tour- 
niquet should  be  treated  by  a  surgeon  as  soon  as  possible. 

The  Carrel-Dakin  method  of  treating  infected  wounds.  During 
the  first  months  of  the  great  war  it  was  found  that  the  infection  of 
wounds  was  a  great  problem  and  that  a  large  percentage  of  the 
deaths  and  deformities  among  wounded  soldiers  was  due,  not 
to  the  wounds  themselves,  but  to  the  bacteria  infecting  them. 
During  the  summer  and  autumn  of  1914  it  seemed  impossible  to 
control  infection,  despite  every  effort  made  both  in  the  -  first 
dressing  and  in  the  after  treatment  at  hospitals.  Shells  and  bullets 


230          Personal  Hygiene  and  Home  Nursing 

damaged  the  tissues  horribly,  carrying  dirt  and  bacteria  into  the 
wound,  and  if  there  was  any  delay  in  getting  the  wounded  man 
to  the  hospital  the  wound  would  be  in  a  dreadful  condition  before 
thorough  treatment  was  possible. 

In  1915  Dr.  A.  Carrel  of  the  Rockefeller  Institute  and  Dr.  H. 
D.  Dakin  of  the  Herter  Laboratories,  both  of  New  York  City, 
working  at  the  laboratories  established  by  the  Rockefeller  Foun- 
dation at  Compiegne  and  at  Temporary  Hospital  No.  21,  Service 
du  Sante  Militaire,  developed  antiseptics  and  methods  of  their 
application  which  have  been  successful  in  the  treatment  of  in- 
fected wounds.  The  treatment  prevents  or  stops  suppuration, 
and  allows  closure  of  the  wound.  The  method  embraces  four 
essential  parts:  (i)  mechanical  cleansing,  (2)  chemical  steriliza- 
tion, (3)  bacteriological  control,  (4)  closure  of  the  wound.  The 
antiseptic  used  is  a  sodium  hypochlorite  solution,  Dakin's  solu- 
tion, which  contains  between  0.5  and  0.4  per  cent  sodium  hypo- 
chlorite and  which  is  not  alkaline  to  powdered  phenolphthalein. 
The  technic  of  applying  the  antiseptic  involves  special  appara- 
tus consisting  of  a  graduated  glass  reservoir  connecting  through 
rubber  and  glass  connecting  tubes  to  small  rubber  distributing 
tubes.  These  tubes,  which  are  perforated  with  small  holes,  are 
so  placed  that  the  antiseptic  solution  is  brought  in  contact  with 
every  part  of  the  wound.  Gauze  compresses  are  placed  over 
and  about  the  tubes,  and  the  whole  is  covered  by  a  pad  of  cotton 
and  gauze.  The  surrounding  skin  is  protected  from  the  irritant 
action  of  the  solution  by  vaselin  compresses  or  by  zinc  oxid  oint- 
ment. The  wound  is  dressed  once  a  day,  and  the  antiseptic 
solution  is  instilled  into  the  wound  every  two  hours,  day  and  night. 

Effects  of  the  treatment.  This  method  of  treating  wounds  has 
been  found  both  inexpensive  and  practical.  Microscopic  examina- 
tion of  the  wound  shows  an  almost  marvelous  disappearance  of 
bacteria.  When  it  is  found  that  all  bacteria  have  disappeared 
from  the  tissue,  the  wound  can  be  sewed  up,  and  it  will  heal  with 
good  muscle  and  practically  no  scar. 


Methods  of  Treating  Wounds  231 

The  results  from  the  treatment  under  war  conditions  have 
been  wonderful.  Wounds  are  quickly  cleansed  of  infection  and 
heal  in  from  one  half  to  one  third  less  time  than  formerly.  The 
danger  of  secondary  hemorrhage  has  been  lessened,  and  the 
patient  recovers  quickly  and  in  much  better  condition.  The 
number  of  amputations  has  been  decreased,  and  when  amputation 
has  been  inevitable  the  stump  is  clean  and  healthy  and  an  artificial 
limb  can  be  used  much  sooner  than  formerly.  Because  of  the 
quick  recovery  of  the  patients  their  stay  in  the  hospital  is  shortened, 
and  their  beds  are  quickly  given  up  to  others,  so  that  many  more 
can  be  treated  with  the  same  equipment.  So  exact  is  the  technic 
of  this  work  as  done  under  Dr.  Carrel,  and  so  certain  the  results, 
that  a  system  of  calculation  has  been  worked  out  by  which  in 
most  cases,  knowing  the  extent  of  the  wound  and  the  age  and  con- 
dition of  the  patient,  it  can  be  estimated  to  a  day  when  he  will 
be  convalescent. 


CHAPTER  THIRTY 


DISLOCATIONS,  FRACTURES,  AND  BANDAGES 

A  DISLOCATION  is  the  slip- 
ping of  a  bone  from  its 
socket,  often  accompanied 
by  thejjreaking  and  tearing 
of  thr*'  gaments  which  hold 
it  in  place ;  a  fracture  is  the 
breaking  of  a  bone.  In 
either  case  the  sooner  the 
patient  is  in  the  hands  of  the 
surgeon  the  better.  Delay 
may  not  only  increase  the 
suffering  of  the  patient  but 
interfere  with  recovery,  or 
even  result  in  permanent 
injury. 

Dislocations.  A  disloca- 
tion can  be  recognized  by 
the  appearance  of  the  joint. 
If  there  is  any  doubt  about 
its  proper  appearance,  com- 
pare it  with  the  joint  on  the 

other  side.  Sometimes  the  head  of  the  humerus  (arm  bone)  can 
be  felt  to  be  out  of  the  socket.  Pain  in  the  joint  and  loss  of  free- 
dom of  movement  are  indications  of  dislocation.  In  some  persons 
a  dislocation  occurs  very  easily  and  should  be  guarded  against. 

There  is  likely  to  be  contusion  and  swelling  around  the  joint, 
and  if  the  swelling  becomes  too  great  before  the  bone  can  be  put 
into  its  place  it  is  difficult  to  handle  it.  Place  your  patient  in  as 
comfortable  a  position  as  possible,  not  moving  the  limb  more  than 
is  absolutely  necessary,  and  then,  to  prevent  swelling,  apply  cold 
or  hot  and  cold  compresses.  Usually  only  a  physician  should 
attempt  to  put  a  dislocated  bone  back  into  place. 

232 


FIG.  70.    The  triangular  bandage  on  the 
head. 


Dislocations,  Fractures,  and  Bandages          233 


FIG.  71.    Laying  the  hand  in  a  triangular  bandage. 

Fractures.  A  fracture  may  be  simple,  compound,  comminuted, 
impacted,  or  greenstick. 

A  simple  fracture  is  one  in  which  the  bone  is  broken,  but  in 
which  there  is  no  opening  through  the  skin. 

A  compound  fracture  is  one  in  which  the  skin  is  pierced  by  the 
end  of  the  broken  bone. 

A  comminuted  fracture  is  one  in  which  the  bone  is  broken  into 
many  pieces. 

An  impacted  fracture  is  one  in  which  the  two  ends  of  the  bones 
have  been  forcibly  driven  together. 

A  greenstick  fracture  is  an  incomplete  fracture,  and  is  common 
in  children,  whose  bones,  not  being  brittle,  do  not  in  many  cases 
break  completely. 

Treatment  of  simple  fractures.  A  simple  fracture,  if  not  handled 
carefully,  can  easily  become  a  compound  one.  If  it  is  not  possible 
to  reach  a  physician  promptly,  it  is  best  to  move  the  patient  as 
little  as  possible.  Leave  him  where  he  is  and  make  him  as  com- 
fortable as  you  can.  If  it  is  necessary  to  move  the  limb,  support 
it  well  at  the  sides  of  the  fracture.  If  the  patient  has  to  be  moved, 
a  temporary  splint  should  be  put  under  the  limb.  The  splint 
is  a  support,  and  can  be  made  of  whatever  is  at  hand,  —  a  pillow 
tied  firmly  around  the  leg  with  strips  of  muslin,  a  bag  stuffed  with 
hay,  a  piece  of  heavy  pasteboard,  a  piece  of  stick  on  each  side  of 


234          Personal  Hygiene  and  Home  Nursing 


FIG.  72.    The  bandage  folded  about  the  hand. 

the  broken  limb,  or  coats  rolled  into  a  tight  wad.  In  putting  on 
the  bandage,  be  careful  not  to  make  it  tight  enough  to  stop  the 
circulation. 

Treatment  of  compound  fractures.  A  compound  fracture  is 
treated  like  a  simple  one,  with  the  additional  point  that  the  open 
wound  must  be  taken  care  of.  If  there  is  profuse  bleeding,  it 
must  be  checked  and  care  taken  not  to  infect  the  wound.  Dress 
it  with  clean  gauze  as  you  would  any  other  open  wound,  and 
watch  the  patient  for  symptoms  of  shock. 

Sprains.  A  sprain  is  caused  by  severe  wrenching  of  the  liga- 
ments around  a  joint,  most  commonly  in  the  wrist  or  ankle.  The 
treatment  should  be  given  as  promptly  as  possible.  If  the  injury 
is  in  the  ankle,  remove  the  shoe,  apply  hot  or  cold  water,  or  hot 
and  cold  water  alternately,  —  as  hot  and  as  cold  as  can  be  en- 
dured, —  putting  the  foot  into  first  one  and  then  the  other  for 
fifteen  to  twenty  minutes.  Then  elevate  the  foot  to  lessen  the 
swelling.  If  the  sprain  is  slight,  the  foot  should  be  allowed  to 
rest  for  several  hours,  and  then  used  moderately  to  prevent  stiff- 
ness. If  the  injury  is  severe,  a  surgeon  should  be  called.  There 
is  a  growing  disposition  to  strap  the  foot  and  leg  with  adhesive 


Dislocations,  Fractures,  and  Bandages          235 


FIG.  73.     Placing  the  foot  in  a  triangular  bandage. 

plaster  and  allow  the  foot  to  be  used.  Massage  is  beneficial,  but 
should  be  given  in  the  proper  manner,  not  too  heavily  at  first. 
There  should  be  passive  exercises  as  soon  as  they  can  be  borne. 

Strains.  A  strain  is  caused  by  overstretching  a  muscle,  some- 
times slowly  in  lifting  a  heavy  weight,  sometimes  quickly  from  a 
sudden  jerk.  It  is  not  as  serious  an  injury  ordinarily  as  a  sprain. 
The  treatment  is  about  the  same  as  for  a  bruise  or  sprain,  —  rest, 
hot  or  cold  applications,  and  rubbing. 

Bruises.  The  discoloration  in  a  bruise  is  from  the  breaking 
down  of  a  number  of  little  blood  vessels  in  the  tissue  under  the 
skin,  by  injury  through  a  blow  or  fall.  The  discoloration  may 
be  caused  by  a  blow  so  slight  that  we  are  not  conscious  of  it ;  usu- 
ally such  a  bruise  needs  no  treatment.  If  it  is  on  the  face,  where 
it  will  be  unsightly,  it  can  be  treated  by  applications  of  alcohol, 
vinegar,  witch  hazel,  ice  water,  or  cold  water,  any  of  which  will 
cause  the  blood  vessels  to  contract  and  check  the  escape  of  blood 
into  the  tissues. 

If  the  blow  has  been  a  severe  one,  use  these  same  remedies  to 
ease  pain  and  allay  inflammation,  and  keep  the  injured  part  raised 
to  lessen  the  blopd  supply.  When  the  acute  inflammation  sub- 
sides, massage  will  help  to  take  out  the  soreness  and  quicken  the 


236          Personal  Hygiene  and  Home  Nursing 


FIG.  74.    The  bandage  folded  about 
the  foot. 


absorption  of  the  blood  in  the 
bruised  part.  If  the  injury  is 
followed  by  shock,  there  may  be 
more  serious  complications,  and  a 
physician  should  be  called.  In 
the  case  of  a  severe  bruise,  it  is 
well  to  have  a  thorough  examina- 
tion made,  to  be  sure  that  there 
is  not  a  fracture. 

Bandages.  Bandages  are  used 
to  keep  dressings  and  splints  in 
place ;  to  make  pressure  to  stop 
bleeding;  to  give  support;  and 
to  protect  injured  parts  against 
knocks  or  blows.  The  two  most 
commonly  used  are  the  triangular 
and  the  roller  bandage. 

The  triangular  bandage.  The  triangular  bandage  can  be  con- 
veniently used  when  it  is  necessary  to  hold  dressings  in  place. 
As  a  rule  it  is  made  of  stout  unbleached  muslin,  but  any  strong 
material  will  do ;  muslin  from  sheets  or  clothing,  or  a  large  hand- 
kerchief, may  be  used.  The  bandage  can  be  folded  into  a  wide 
or  a  narrow  strip,  or  can  be  used  in  the  triangular  form.  The 
usual  size  for  a  triangular  bandage  is  the  triangular  half  of  a  yard 
of  material,  but  sometimes,  in  an  emergency,  a  piece  as  large  as 
this  cannot  be  obtained.  There  are  certain  rules  for  applying 
this  bandage,  but  one  must  plan  somewhat  according  to  the  size 
and  the  part  to  which  it  is  to  be  applied.  The  following  instruc- 
tions will  help  in  fitting  the  triangular  bandages  on  some  of  the 
parts  of  the  body  on  which  it  is  commonly  used : 

Bandaging  the  head.  When  the  bandage  is  large,  place  it  over 
the  head  with  the  middle  of  the  folded  edge  well  forward  on  the 
forehead  and  the  point  hanging  down  the  back.  Bring  back  the  two 
ends,  which  hang  down  the  side  of  the  head,  and  cross  them  well 


Dislocations,  Fractures,  and  Bandages          237 


FIG.  75.    The  triangular  bandage  used  as 
an  arm  sling. 


down  at  the  back ;  then  bring 

them  around  to  the  front  and 

tie   them   on   the   forehead. 

Turn  up  the  point  in  the  back 

and  fasten  it  with  a  pin.    The 

ends  of  the  bandage  are  tied 

in  front,  so  that  there  will  be 

no  knot  under  the  head  when 

the  patient  is  lying  down. 
When  the  bandage  is  small, 

put  the  point  in  front  and  the 

middle  of  the  bandage  at  the 

back;   tie  the  ends  in  front 

and  turn  the  point  which  is 

hanging  over  the  face  up  over 

the  knot  and  pin  it  with  a 

safety  pin. 

Bandaging  the  hand  and  foot.    Lay  the  hand  on  the  bandage, 

with  the  palm  down    and  fingers  toward  the    point;    fold  the 

point  up    over    the  back  of   the    hand;    wrap    the  two    ends 

around  the  wrist  and  tie  them. 

Bandage  the  foot  like  the  hand, 
after  placing  it  on  the  bandage  with 
the  toes  toward  the  point. 

The  arm  sling.  Let  the  point  of  the 
triangle  come  out  beyond  the  elbow. 
The  end  running  under  the  arm 
goes  across  the  chest  to  the  side  of 
the  neck  away  from  the  injured  arm ; 
the  other  end  goes  around  the  neck 
on  the  side  of  the  injured  arm ;  and 
the  two  ends  are  then  tied  around  the 

FIG.  76.    A  roller  bandage  on  the  ,        T        ,         ,  .    .    .      ,  ,  , 

wrist,  and  the  method  of  reversing    neck.      Lastly,   the   point   IS    brought 


a  bandage. 


up  around  the  elbow  and  pinned. 


238          Personal  Hygiene  and  Home  Nursing 


Triangular  bandage  folded.  When  the  triangular  bandage  is 
folded  with  the  point  in,  it  can  be  used  for  eye,  jaw,  hand,  or 
wherever  a  narrow  bandage  is  needed. 

The  roller  bandage.  The  roller  bandage  is  made  of  gauze, 
flannel,  muslin,  crinoline,  or  rubber,  according  to  the  purpose 
for  which  it  is  designed.  In  an  emergency  any  material  that 
is  pliable  and  strong  can  be  used.  The  bandage  is  torn  into 
different  widths  according  to  the  part  of 
the  body  to  which  it  is  to  be  applied. 
The  usual  widths  are:  for  a  finger, 
three  fourths  of  an  inch ;  for  arm  and 
head,  two  and  one  half  inches;  for  leg 
and  thigh,  three  inches ;  for  chest  and 
abdomen,  four  to  five  inches. 

A  roller  bandage  is  much  harder  to 
apply  neatly  than  a  triangular  one,  but 
a  little  practice  will  make  one  skillful  in 
its  use.  Certain  points  must  be  ob- 
served. Apply  the  bandage  firmly  and 
evenly,  but  be  careful  not  to  have  it 
too  tight.  After  an  injury,  put  on  a 
loose  bandage  to  allow  for  possible 
swelling. 

The  circular  method  of  applying  a 
roller  bandage  is  the  easiest,  and  when 
used  to  hold  a  splint  in  place  is  the  one 
generally  employed.  Gauze  and  flannel 
bandages  can  be  used  best  in  this  way, 
as  they  are  pliable  and  soft.  A  circular 
bandage  will  not  be  even  in  pressure  if 
the  surface  to  be  covered  is  larger  in  one 
part  than  in  another,  and  to  make  the 
bandage  lie  flat  and  even  we  use  "re- 
verses "  and  "  figure  eights." 


FIG.  77.     A  roller  bandage 
on  the  band  and  foot. 


Dislocations,  Fractures,  and  Bandages          239 


FIG.  78. 


A  roller  bandage  about  the 
knee. 


FIG.  79.    A  roller  bandage  on  the 
foot. 


The  reverse  is  made  in  this  way:  With  the  roll  in  the  right 
hand,  press  the  thumb  of  the  left  on  the  lower  edge  of  the  bandage 
and  hold  it  in  place ;  loosen  the  pull  of  the  right  hand  on  the 
bandage  and  make  a  quick  turn  of  the  roller  toward  you,  mak- 
ing a  fold  before  taking  it  again  under  the  limb.  When  several 
reverses  are  made,  they  should  form  a  line  up  the  limb. 

The  figure  eight  bandage  is  used  to  cover  joints.  To  apply  it, 
fix  the  end  of  the  bandage  by  several  circular  turns  below  the 
joint ;  carry  the  bandage  up  and  make  the  circular  turns  immedi- 
ately over  the  joint;  next  make  a  turn  a  little  below  the  joint, 
overlapping  well  the  bandage  covering  the  joint ;  then  a  turn 
under  and  next  above  the  joint,  overlapping  above  as  was  done 
with  the  one  below.  Continue  in  this  way,  going  first  below  and 
then  above,  until  well  above  and  below  the  joint.  When  the 
point  of  the  joint  does  not  need  to  be  covered,  omit  the  two  turns 
immediately  over  the  joint. 


CHAPTER  THIRTY-ONE 
TOT  TRAINED  NURSE 

BELIEVING  that  better  understanding  of  the  training  and  duties 
of  a  nurse,  by  those  who  employ  her,  would  not  only  make  her 
work  easier,  but  more  effective,  I  introduced  in  one  of  my  lectures 
a  brief  talk  about  the  trained  nurse  and  her  work.  The  class  was 
eager  for  a  wider  knowledge  of  the  subject  than  could  be  given 
in  the  time,  and  many  questions  were  asked  by  this  and  other 
groups  of  students,  concerning  the  training  of  a  nurse,  why  it  is  so 
severe,  what  was  required  of  the  applicant,  what  type  of  hospital 
was  best,  and  what  positions  nurses  were  filling.  Questions  were 
also  asked  as  to  the  ways  of  helping  the  nurse  in  her  work,  mak- 
ing her  life  happier,  conserving  her  strength,  and  aiding  in  her 
efforts  for  the  benefit  of  the  patient. 

In  this  chapter  I  am  trying  to  answer  these  questions  and  also 
to  give  information  likely  to  be  of  interest  to  those  who  wish  to 
become  nurses,  as  well  as  to  those  who  employ  a  trained  nurse  in 
their  homes.  A  nurse's  life  is  not  an  easy  one,  and  many  nurses 
are  broken  down  in  health  and  obliged  to  give  up  their  work  earlier 
than  are  women  of  other  professions.  In  many  cases  this  could 
be  avoided  if  those  in  whose  homes  they  worked  took  care  not  to 
subject  them  to  unnecessary  privation  and  fatigue.  There  is  no 
advantage  either  to  nurse  or  patient  in  the  nurse's  wasting  need- 
lessly the  strength  she  requires  for  her  real  work.  Few  professions 
are  more  interesting  and  more  developing  than  that  of  the  trained 
nurse,  hard  and  exacting  as  the  training  is.  There  is  a  fascination 
and  a  broadening  influence  in  the  training  that  might  well  be 
valuable  to  any  woman. 

Requirements  for  applicants.  Certain  requirements  are  common 
to  most  if  not  all  hospitals.  The  applicant  must  be  healthy,  must 
have  passed  through  the  high  school,  must  give  at  least  two  letters 
certifying  to  her  moral  standing,  and  must  in  most  hospitals  be 
at  least  twenty-two  years  old.  Some  hospitals  are  less  exacting 
in  their  requirements  than  others,  and  admit  women  even  as  young 

240 


The  Trained  Nurse  341 

as  eighteen  years  of  age.  Any  one  in  search  of  thorough  training 
will  do  well  not  to  choose  such  a  hospital.  Eighteen  is  too  young 
to  begin  the  training ;  a  girl  of  eighteen  has  not  the  experience 
mentally  or  physically  to  meet  some  of  the  difficulties  she  may 
encounter,  and  in  many  cases  she  begins  the  training  impulsively, 
without  any  real  understanding  of  her  undertaking.  As  a  rule 
the  hospital  which  will  take  a  girl  of  eighteen  is  a  small  hospital 
for  children.  There  is  possibly  no  objection  to  taking  the  training 
there  if  one  is  seeking  simply  experience  in  nursing  children ;  but 
it  is  much  better  to  take  a  good  all-round  training  in  a  general 
hospital,  and  then,  if  it  seems  desirable  to  specialize  in  any  one 
branch  of  the  work,  to  take  whatever  special  training  is  necessary 
with  the  aid  of  the  solid  foundation  of  general  experience.  A 
nurse  cannot  be  trained  by  correspondence.  That  is  impossible. 
She  must  come  into  personal  contact  with  the  patient,  learning 
to  take  temperature  and  give  other  treatment  in  order  to  be  able 
to  understand  her  work. 

Large  and  small  schools.  In  most  ways  the  schools  in  the 
larger  cities  are  the  better,  because  they  have  the  means  to  give 
the  best  training,  and  the  number  of  patients  is  large  enough  to 
afford  good  experience.  In  some  small  hospitals,  however,  there 
are  certain  advantages.  A  nurse  in  a  small  hospital  can  see  and 
study  each  case,  while  in  a  large  hospital  her  duties  are  hard,  and 
she  is  frequently  not  permitted  to  go  from  one  ward  to  another. 
Thus  she  misses  some  things  in  her  training  which  are  gained  by 
the  nurse  in  the  small  school. 

The  registered  nurse.  Many  states  have  passed  laws  permit- 
ting registration  to  hospitals  and  nurses.  A  hospital,  to  be  regis- 
tered, must  not  have  below  a  certain  number  of  patients,  and  the 
instruction  given  to  the  nurses  training  in  the  school  must  be  up 
to  a  certain  standard. 

A  nurse,  to  register,  must  prove  that  she  is  a  graduate  of  a 
registered  school,  that  she  is  of  good  moral  character,  and  that  her 
work  both  in  the  school  and  since  leaving  it  are  up  to  the  standard. 


242          Personal  Hygiene  and  Home  Nursing 

She  must  pass  an  examination  in  anatomy  and  physiology,  materia 
medica,  and  other  subjects  considered  necessary  by  an  examining 
board  appointed  by  the  state.  She  is  then  entitled  to  write  after 
her  name  the  letters  "  R.  N."  (Registered  Nurse).  This  registra- 
tion of  nurses  was  started  in  an  effort  to  raise  the  standard  of  train- 
ing for  nurses  and  as  a  means  of  helping  those  employing  them  to 
obtain  nurses  of  good  training  and  good  character. 

Health  of  nurses  in  hospitals.  In  most  hospitals  attention  is 
given  particularly  to  the  health  of  the  nurse,  and  in  many  cases 
young  women  who  enter  a  hospital  in  a  somewhat  run-down  or 
nervous  condition  leave  in  much  better  health.  It  is  well  to  inves- 
tigate the  feeding  of  the  nurses  before  deciding  upon  a  school.  In 
some  schools  the  food  is  very  poor,  and  a  demand  for  good  food 
by  applicants  choosing  schools  would  greatly  help  in  improving 
these  conditions. 

Severity  of  training.  The  training  of  the  nurse  is  exceedingly 
hard,  possibly  sometimes  unnecessarily  so;  but  when  the  life  of 
the  graduate  nurse  is  considered,  —  the  long  hours,  the  severe 
mental  and  physical  strain,  and  the  responsibility  of  her  work,  — 
it  is  evident  that  vigorous  training  in  the  hospital  is  absolutely 
necessary  as  a  preparation.  During  certain  periods  of  her  hospital 
work,  the  nurse  is  often  on  duty  for  eighteen  hours  out  of  the 
twenty-four ;  but  only  in  this  way  can  it  be  certain  that  she  will 
be  able  to  undertake  any  and  every  kind  of  work  which  is  a  part 
of  a  trained  nurse's  life. 

Positions  open  to  nurses.  Formerly  the  only  future  for  a  nurse 
after  graduation  was  to  continue  in  the  hospital,  taking  charge  of 
a  ward  or  of  the  hospital  itself,  or  to  go  into  private  nursing. 
Year  by  year,  however,  there  are  more  and  more  places  where  a 
nurse  is  needed.  If  statistics  were  to  be  taken,  it  might  be  found 
that  trained  nurses  are  in  all  kinds  of  positions.  They  are  secre- 
taries, companions,  lecturers  or  residents  in  schools  and  colleges, 
nurses  by  the  hour  in  the  homes  of  rich  or  poor,  and  housekeepers 
in  schools  and  hospitals.  Other  things  being  equal,  in  many 


The  Trained  Nurse  243 

forms  of  school  work  the  trained  nurse  will  be  preferred  to  an 
equally  able  woman '%ithout  this  training,  in  any  position  of 
responsibility. 

Duties  of  the  nurse  to  the  patient.  The  nurse  goes'  into  a  house 
to  take  care  of  the  patient.  Whatever  is  necessary  for  the  patient's 
health  and  comfort  is  a  part  of  her  task.  In  the  case  of  a  delirious 
patient,  or  one  who  is  easily  excited  by  the  presence  of  others,  the 
nurse  should  take  care  of  the  sick  room.  If  the  presence  of  a  third 
person  is  exciting  to  the  patient,  and  the  sweeping  of  the  room  by 
the  nurse  will  lessen  this  nervousness,  this  work  should  be  done  by 
her.  If,  as  often  happens,  food  is  as  much  a  part  of  the  treatment 
as  medicine,  and  no  one  in  the  house  can  prepare  it  properly,  the 
nurse  should  assume  this  duty.  I  have  known  of  good  nurses, 
anxious  to  do  what  was  right  by  the  patient,  who  went  out  to  the 
market  and  bought  the  food,  and  cooked  it  and  served  it  to  the 
patient.  A  nurse  should  not  say,  "  This  is  not  my  work ;  that  is 
not  my  work ;  if  it  is  not  well  done  it  is  no  affair  of  mine."  Occa- 
sionally a  nurse  will  say,  "  My  work  is  only  in  the  bedroom.  I 
do  not  go  out  of  the  room."  I  have  known  nurses  to  carry  this 
to  the  extreme  of  requiring  a  maid  to  carry  vessels  from  the  bed- 
room to  the  bathroom  to  empty  them.  The  nurse's  work  is  to 
do  what  is  necessary  for  the  patient,  give  her  treatments,  keep  her 
records ;  and  if  the  inefficiency  or  negligence  of  others  obliges  her 
to  supplement  her  own  work  by  doing  some  of  theirs  in  order  to 
insure  the  recovery  of  the  patient,  she  should  not  maintain  her 
own  rules  at  the  expense  of  her  charge. 

One  winter  I  took  charge  of  a  woman  who  had  been  insane  for 
about  two  weeks  and  in  charge  of  a  nurse.  The  physician  gave  me 
directions  to  allow  no  member  of  the  household  to  come  into  the 
room,  as  this  had  from  the  first  excited  the  patient  to  the  point  of 
frenzy.  Two  or  three  days  after  I  went  there,  the  laundress  asked 
if  I  would  give  her  a  bag  of  laundry  hanging  in  the  closet  in  the 
patient's  room.  As  I  handed  her  the  bag  she  said,  "  Thank 
Heaven,  at  last  the  children  will  be  able  to  have  a  change  of  cloth- 


244          Personal  Hygiene  and  Home  Nursing 

ing."  Then  she  explained  that  the  bag  of  laundry  had  been  in 
that  closet  ever  since  the  illness  of  the  patient  began.  When  the 
nurse  in  charge  had  been  asked  to  give  it  to  the  laundress,  she  had 
refused,  saying  that  she  had  come  to  the  house  to  nurse  a  patient, 
not  to  collect  the  family  wash ! 

Needless  to  say,  the  nurse  owes  to  the  family  a  sympathy  and 
understanding  which  should  make  any  such  occurrence  as  this 
unimaginable.  When  it  is  right  and  suitable  for  her  to  answer  a 
question  she  should  do  so,  remembering  at  the  same  time  that 
she  is  not  there  to  diagnose  or  prognosticate  the  case.  She  should 
be  careful  in  expressing  an  opinion,  and  should  never  criticize  the 
physician,  but  should  carry  out  his  orders  with  all  possible  ac- 
curacy. She  should  remember  that  the  business  of  the  family  is 
not  her  business,  and  whatever  she  may  see  and  hear  in  the  course 
of  her  duties  is  never  to  be  spoken  of  in  other  houses. 

Duties  of  the  patient  to  the  nurse.  The  nurse  is  in  the  room  to 
do  what  is  necessary  for  the  patient,  and  in  a  person  who  is  ill, 
much  is  to  be  overlooked  and  excused.  Nevertheless,  there  are 
patients  who  take  advantage  of  this  and  call  upon  the  nurse  un- 
necessarily, particularly  at  night.  Moreover,  the  nurse  is  only 
human,  and  no  matter  how  much  she  may  wish  to  do  so  she  may 
not  always  do  things  at  first  as  the  patient  is  accustomed  to  hav- 
ing them  done.  A  little  patience  on  the  part  of  the  patient  will 
enable  the  nurse  to  learn  more  quickly  and  make  her  work  more 
satisfactory.  It  must  be  recognized  also  that  upon  the  patient 
lies  a  part  of  the  responsibility  of  recovery,  and  that  if  the  nurse's 
advice  is  not  followed,  and  fretting  and  impatience  interfere  with 
the  well-being  of  the  invalid,  neither  nurse  nor  physician  can  do 
the  work  as  well  as  it  would  have  been  done  with  the  cooperation 
of  the  patient. 

Duties  of  the  family  to  the  nurse.  If  no  nurse  experienced  the 
lack  of  consideration  found  in  certain  families,  fewer  families  would 
have  to  complain  that  the  nurse  will  not  go  outside  her  own  speci- 
fied duties.  If  nurses  were  always  careful  not  to  lay  unnecessary 


The  Trained  Nurse  245 

burdens  upon  the  servants,  fewer  employers  would  let  the  nurse 
wait  upon  herself  rather  than  see  that  she  was  cared  for  by  the 
maids.  The  unfortunate  feature  of  the  situation  is  that  the  con- 
sequences of  selfishness  and  injustice  do  not  usually  fall  upon  those 
who  commit  the  offense,  but  upon  those  who  really  want  to  be 
fair  and  kindly.  The  nurse  who  might  not  object  to  doing  more 
than  her  duty  may  be  forced  in  self-defense  to  make  a  rule  and 
keep  to  it,  in  order  not  to  be  overworked. 

The  family  should  not  require  needless  work  of  the  nurse.  Un- 
less there  is  some  reason  for  the  nurse's  sweeping  the  floor  and 
dusting  the  room,  the  work  should  be  done  by  the  person  who 
usually  performs  it.  If  the  cook  is  competent  to  prepare  the  food, 
the  nurse  should  not  be  obliged  to  leave  her  patient  and  go  into 
the  kitchen.  If  possible,  the  sick  room  should  communicate  with 
the  bath,  or  at  any  rate  be  on  the  same  floor ;  for  when  the  sick 
room  is  on  one  floor  and  the  bathroom  on  another,  it  entails  great 
additional  fatigue  in  caring  for  the  patient.  One  nurse  whom  I 
know  was  in  bed  for  months,  with  a  strained  back,  because,  hav- 
ing three  patients  instead  of  the  two  she  had  expected,  she  had 
also  to  carry  all  bath  water  from  the  second  floor  to  the  third  and 
down  again.  She  gave  out  early  in  the  case,  and  her  financial  loss 
from  months  of  enforced  idleness  was  serious.  If  some  one  had  been 
detailed  to  attend  to  this  piece  of  manual  labor,  it  would  certainly 
have  been  far  better  economy  than  to  consume  in  it  the  strength  of 
a  trained  specialist,  which  was  needed  for  the  care  of  her  charges. 

Often,  by  a  little  thought,  extra  care  and  work  for  the  nurse  can 
be  avoided.  She  cannot  rearrange  the  furniture  of  other  people's 
houses,  but  if  a  patient  on  the  second  or  third  floor  is  on  a  liquid 
diet,  an  ice  box  can  be  provided  there  in  which  to  keep  the  milk. 
Means  may  be  supplied  for  her  to  heat  water,  make  tea  or  cocoa, 
and  do  other  work,  on  the  same  floor  as  the  sick  room,  instead  of 
in  the  kitchen,  where  it  will  interfere  with  the  routine  of  the  house- 
hold. Things  which  the  nurse  knows  will  be  needed  can  be  kept 
on  hand. 


246          Personal  Hygiene  and  Home  Nursing 

Miscellaneous  extra  duties  required.  A  nurse  engaged  for  one 
patient  is  not  a  resident  physician,  and  should  not  be  constantly 
called  upon  to  treat  other  members  of  the  family  on  her  own  re- 
sponsibility. In  some  households  it  seems  to  be  taken  for  granted 
that  the  duties  of  the  nurse  include  general  oversight  of  the  family. 
Medicines  are  handed  over  to  the  nurse  to  give  to  the  children, 
though  the  mother  or  governess  may  have  been  administering 
them  for  months.  She  is  asked  to  wash  out  eyes,  give  enemas, 
advise  about  diet,  even  to  prescribe  for  ailments  and  answer  ques- 
tions which  should  be  asked  of  the  doctor.  If  her  patient  is  not 
seriously  ill,  she  is  usually  glad  to  be  helpful ;  but  many  a  nurse, 
after  working  hard  with  a  patient,  has  been  required  to  spend  the 
few  minutes  which  she  might  have  used  for  rest,  in  some  attention 
to  another  member  of  the  family.  There  are  many  women  who 
seem  to  feel  that  any  one  who  is  "  in  the  house  and  not  busy  just 
now,"  even  if  engaged  for  certain  duties  which  are  well  done, 
ought  to  be  kept  occupied.  It  is  well  to  remember  that  business  is 
business,  and  that  if  you  engage  a  person  for  certain  duties  you 
have  no  right  to  require  anything  more  of  her. 

Recreation  and  rest.  The  nurse  is  entitled  to  her  hours  off  for 
recreation.  When  the  patient  is  extremely  ill  she  often  gives  up 
this  time,  remains  within  call,  never  goes  out,  and  works  with  all 
her  mind  and  heart  and  body  to  save  the  life  and  health  of  her 
helpless  charge.  At  the  end  of  that  time,  when  convalescence 
has  begun,  she  not  only  may  but  should  take  her  due  time  for 
recreation,  and  it  is  only  fair  for  the  employer  to  give  it  to  her 
freely  and  ungrudgingly. 

The  kindness  and  appreciation  of  the  mother  of  one  of  my  early 
patients  is  always  a  bright  memory.  The  boy  was  ill  with  typhoid 
fever,  and  as  there  had  been  two  deaths  from  this  disease  in  the 
immediate  family,  anxiety  about  the  case  was  natural.  He  had  a 
rather  mild  attack,  but  to  relieve  the  strain  upon  the  mother  I 
stayed  in  very  closely,  not  taking  my  daily  walk,  and  remained 
within  call  until  he  was  out  of  danger.  I  then  found  that  the 


The  Trained  Nurse  247 

mother  wished  me  to  go  out  for  the  whole  afternoon  every  day. 
I  reminded  her  that  she  was  giving  me  more  than  was  my  due,  and 
she  said  that  I  had  given  her  many  long  hours  to  which  I  was  en- 
titled. I  suggested  to  her  that  a  nurse's  hours  of  rest  were  not 
usually  cumulative,  and  that  as  she  was  doing  what  few  would 
think  of,  she  might  spoil  me. 

"  I  hope,"  she  said,  "  that  you  will  find  you  are  mistaken  about 
that.  If  you  do  not,  I  shall  like  to  think  that  you  will  look  back 
upon  this  case  with  pleasure,  and  remember  our  great  apprecia- 
tion and  gratitude  to  you  for  the  care  and  thought  which  you  have 
given  us." 

More  generous  giving  might  exist  in  this  world  if  it  met  with 
more  generous  receiving,  but  the  attitude  of  a  great  many  people 
is  expressed  in  the  old  proverb,  "  The  more  you  do,  the  more  you 
may  do,"  and  this  inevitably  tends  to  cool  the  ardor  of  those  who 
would  like  to  give  themselves  freely. 

The  nurse's  bed.  When  a  nurse  spends  weeks  of  hard  work, 
perhaps,  helping  to  bring  a  well-loved  member  of  the  family  back 
from  death,  she  sometimes  has  nothing  in  the  way  of  a  bed  but  a 
cot  or  an  uncomfortable  makeshift  couch.  The  family  argues  that 
it  is  only  a  temporary  arrangement,  and  there  is  no  need  of  going 
to  the  expense  of  buying  a  bed.  One  thing  which  breaks  down 
the  health  of  nurses  is  the  uncomfortable  way  in  which  they  have 
to  sleep.  A  member  of  the  family  may  for  a  week  or  two,  during 
some  one's  serious  illness,  sleep  on  a  couch,  or  on  a  mattress  on  the 
floor,  but  at  the  end  of  that  time  he  goes  back  to  a  comfortable 
room;  the  nurse  goes  from  one  patient  to  another  and  one  tem- 
porary sleeping  berth  to  another,  year  in  and  year  out.  I  knew 
of  one  case  in  which  the  nurse  slept  for  seven  weeks  on  a  couch  so 
short  that  she  had  to  put  her  feet  on  a  chair  at  the  foot  of  the 
couch  and  so  narrow  that  when  she  wanted  to  turn  over  she 
had  to  stand  up,  turn  around,  and  lie  down  again.  Cases  of 
this  kind  occur,  not  in  the  houses  of  the  poor,  but  in  the  ordinary 
emergencies  of  well-to-do  people.  The  nurse  has  no  remedy 


248          Personal  Hygiene  and  Home  Nursing 

but  to  give  up  the  case,  and  that  for  obvious  reasons  she  cannot 
often  do. 

The  nurse's  meals.  It  is  very  hard  for  a  woman  to  sit  up  all 
night,  working  hard,  possibly  having  a  very  poor  lunch,  and  when 
morning  comes  and  she  is  thoroughly  exhausted,  to  see  the  mem- 
bers of  the  family,  after  a  good  night's  rest,  go  down  to  breakfast 
and  then,  possibly  at  nine  or  half-past  nine  or  ten  o'clock,  remem- 
ber that  the  nurse  should  have  hers.  An  early  cup  of  coffee  or  an 
early  breakfast  does  much  to  keep  her  from  becoming  fatigued. 
Personal  oversight  should  be  given  to  the  midnight  tray  for  the 
nurse.  Many  maids  are  careless  in  its  preparation,  sometimes 
forgetting  it  entirely.  There  is  no  exhaustion  greater  than  that 
of  a  tired  nurse  between  two  and  five  o'clock  in  the  morning ;  and 
it  does  not  help  her  when  she  goes  to  her  room,  hoping  to  brace 
herself  with  food  against  those  early  morning  hours,  to  find  a  tray 
carelessly  prepared,  lacking  salt,  pepper,  or  sugar,  with  thick  slices 
of  bread  and  weak  coffee,  and  showing  in  every  way  that  no  one 
has  given  thought  to  her  and  her  comfort. 

Contrast  with  such  neglect  one  of  my  cases,  that  of  a  man 
critically  ill  of  pneumonia,  who  was  given  an  open-air  treatment  in 
midwinter  —  always  hard  on  the  nurse.  At  one  o'clock  each  morn- 
ing his  daughter  would  call  me  to  my  supper,  prepared  with  her 
own  hands  —  hot  soup  or  oysters,  hot  coffee  or  chocolate,  on  a 
dainty  tray,  served  in  the  most  tempting  fashion. 

"  I  could  never  be  happy,"  she  said,  "  if  I  knew  that  any  one 
was  working  as  hard  as  you  do  for  a  member  of  my  household  and 
I  was  not  doing  everything  that  I  could  to  make  her  comfortable." 

She  was  one  woman  in  a  thousand,  and  nurses  do  not  expect 
such  thought  as  that ;  but  they  have  a  right  to  expect  a  little  care 
from  people  for  whom  they  are  doing  so  much.  Nurses  excuse 
this  thoughtlessness  by  saying,  "  People  are  worried  and  don't 
think,"  and  this  no  doubt  is  true  in  many  cases. 

Excessive  fatigue  in  the  nurse  naturally  reacts  against  her  work 
in  her  care  of  the  patient.  See  that  she  has  her  hours  of  rest  and, 


The  Trained  Nurse  249 

where  it  is  necessary,  bring  in  a  nurse  to  relieve  her.  One  of  the 
wonders  of  the  world  is  the  few  mistakes  that  are  made  by  nurses 
who  have  worked  to  such  a  point  of  exhaustion  that  they  should 
not  be  held  mentally  or  physically  responsible  for  their  acts.  If  a 
nurse  asks  to  have  some  one  relieve  her  and  stay  in  the  room  when 
she  is  out  attending  to  other  things,  be  ready  to  give  her  this  help ; 
for  often  the  nurse  who  is  with  a  case  constantly  recognizes  slight 
delirium  long  before  the  doctor  can  see  it.  A  delirious  patient  is 
always  anxious  to  get  out  of  bed.  Many  times,  when  she  appears 
to  be  all  right,  she  is  slightly  delirious ;  and  many  accidents  can 
be  avoided  by  the  willingness  of  the  family  to  relieve  the  nurse 
when  she  asks  them  to  do  so. 

Visits  from  the  family.  The  visits  of  the  family  to  the  patient 
should  be  subject  to  the  orders  of  the  physician  and  the  judgment 
of  the  nurse.  When  a  patient  is  very  weak,  constant  visits  from 
che  family  and  friends  are  fatiguing.  Sometimes  a  certain  mem- 
ber of  the  family  will  irritate  and  excite  the  patient.  When  deliri- 
ous, people  are  often  most  excited  or  even  irritated  by  the  presence 
of  those  whom  they  love  best.  When  a  physician  orders  a  mem- 
ber of  the  family  kept  out  of  the  room,  the  family  should  under- 
stand that  it  is  done  absolutely  for  the  good  of  the  patient,  and 
respect  the  order. 

When  permitted  to  go  into  the  sick  room,  a  visitor  should  stay 
only  as  long  as  the  doctor  has  given  him  leave  to  stay.  If  the 
patient  is  fatigued  before  the  time  is  up,  and  the  nurse  asks  the 
visitor  to  leave,  no  irritation  should  be  felt  in  acceding  to  this 
request.  Many  patients  have  had  relapses  because  of  fatigue  from 
seeing  their  friends  too  long.  If,  when  the  doctor  has  given  per- 
mission to  one  or  two  persons  to  see  the  patient,  those  who  come 
first  are  allowed  to  go  in,  the  later  comers  should  feel  no  pique  or 
sensitive  unhappiness  at  not  being  allowed  to  follow.  The  nurse 
is  simply  carrying  out  the  doctor's  orders,  and  it  is  of  no  personal 
importance  to  her  who  is  allowed  to  come  into  the  sick  room,  except 
in  as  far  as  it  affects  the  patient. 


INDEX 


Abdominal  organs,  correct  and  incorrect 
position  of,  78-79. 

Abdominal  poultices,  129. 

Abscesses,  alveolar,  18-19;  in  the  ears,  54; 
poultices  not  used  for,  129 ;  of  the  brain, 
following  measles,  143. 

Acids,  rules  for  giving,  as  medicines,  188, 
100 ;  antidotes  for,  209. 

Aconite,  treatment  for  poisoning  by,  212. 

Adenoid  growths,  56-59. 

Alcohol,  as  a  disinfectant,  135 ;  hardening 
of  the  arteries  due  to  use  of,  178;  treat- 
ment for  poisoning  by,  212;  used  in 
treating  cuts,  225. 

Alkali,  antidotes  for,  209. 

Aloin,  effects  of,  50. 

Amberine,  for  treating  burns,  218. 

American  Posture  League,  shoe  recom- 
mended by,  24. 

Anemia,  caused  by  pyorrhea,  18. 

Antidotes  for  poisons,  209. 

Antitoxin,  use  of,  for  diphtheria,  141,  146. 

Appendicitis,  as  a  result  of  pyorrhea,  18. 

Appetite,  loss  of,  a  symptom  of  fatigue, 
28 ;  ill  effects  of  lack  of,  30. 

Arches  of  feet,  pain  in,  87. 

Arsenic,  preparations  of,  and  treatment  for 
poisoning  by,  211. 

Arterial  hemorrhage,  227. 

Arteriosclerosis,  description  and  treatment 
of,  177-178. 

Arthritis  deformans,  due  to  pyorrhea,  18; 
description  and  treatment  of,  170-181. 

Artificial  respiration,  200-206. 

Aspirin,  danger  in  use  of,  192. 

Atropin,  treatment  for  poisoning  by,  212. 

Babies,  care  of  mouth  of,  10-11 ;  adminis- 
tering artificial  respiration  to,  202-203, 
206. 

Bacteria,  communicable  diseases  caused  by, 
132 ;  non-communicable  diseases  caused 
by,  176-181. 

Bandages  and  bandaging,  232-239. 

Bathing,  frequency  of,  4 ;  cold,  5 ;  hot,  6 ; 
tepid,  6 ;  of  feet,  7 ;  special  baths,  7  ; 
of  skin  of  the  face,  7-9 ;  of  the  hands,  9 ; 
during  menstrual  period,  36-37 ;  of  a 
patient  in  bed,  1 16-1 20 ;  in  case  of  com- 
municable diseases,  142;  of  typhoid 


fever  patients,  168-169;  for  convulsions, 

197. 

Bed  making,  104-115. 
Bed  rests,  113,  114-115. 
Bedside  notes,  form  for,  94. 
Bed  sores,  avoidance  and  treatment  of,  170. 
Belladonna,    treatment   for  poisoning  by, 

213- 
Benzoin,  tincture  of,  as  a  steam  inhalative, 

64. 
Bichlorid  of  mercury,   as  a  disinfectant, 

134 ;  treatment  for  poisoning  by,  209. 
Billings,  Dr.  Frank,  cited  on  chronic  in- 
fections, 176,  177. 

Biniodid  of  mercury  as  a  disinfectant,  135. 
Blackheads,  cause  of,  7. 
Body,  structure  of  the  human,  73-87. 
Bones  in  the  human  body,  74-77. 
Bowels,  hemorrhage  of,  in  typhoid  cases, 

96,  168,  169;  irrigating  the,  124-126. 
Bowen,    W.    P.,    Applied    Anatomy    and 

Kinesiology,  quoted,  77-78. 
Braces,  use  of,  in  cases  of  defects,  90; 

for  paralyzed  children,  154. 
Brain,  concussion  of  the,  199. 
Bright's  disease,  tendency  to,  after  measles, 

143 ;  following  scarlet  fever,  145 ;  caused 

by  bacteria,  181. 
Broths,  preparation  of,  186. 
Bruises,  treatment  of,  235-236. 
Bunions,  cause  and  treatment  of,  86-87. 
Burns,  classes  and  treatment  of,  217-221. 

Calomel,  dangers  of  too  free  use  of,  50-51, 

192. 
Camphor,    treatment    for    poisoning    by, 

213- 
Cancer,  occurrence  of,  during  menopause, 

30-40. 
Canned  goods,   cooking  of,  before  using, 

206. 

Capillary  hemorrhage,  227. 
Carbolic    acid,    as    a    disinfectant,    134; 

treatment  for  poisoning  by,  210-211. 
Carrel-Dakin  method  of  treating  infected 

wounds,  229-231. 
Carriers  of  disease  germs,  136-137. 
Carroll,  Dr.  James,  i. 
Carron  oil,  for  treating  burns,  218, 
Cascara  sagrada,  effects  of,  50, 


251 


252 


Index 


Castor  oil,  taking  of,  50;  for  ptomain 
poisoning,  207. 

Cathartics,  a  cause  of  constipation,  43; 
classification,  use,  and  effects  of,  49-51. 

Caustic  potash  poisoning,  216. 

Chairs,  faulty  posture  in  children  due  to 
unsuitable,  82-83. 

Change  of  life,  38-40. 

Charts,  keeping  of,  03-95 ;  in  typhoid  fever 
and  pneumonia  cases,  167. 

Cheerfulness  in  the  sick  room,  97-98. 

Chicken  pox,  description  and  treatment 
of,  147- 

Chloral,  treatment  for  poisoning  by,  213. 

Chloroform,  treatment  for  poisoning  by, 
213- 

Cholagogues,  49. 

Chorea,  following  scarlet  fever,  145;  a 
complication  of  rheumatic  fever,  178; 
caused  by  bacteria,  181. 

Chronic  infections,  diseases  due  to,  176- 
181. 

Clothing,  choosing  proper,  20-22;  in- 
correct posture  caused  by  improper 
hanging  of,  82. 

Coal-tar  derivatives,  as  disinfectants,  134; 
dangers  in  taking,  193. 

Coca-cola,  danger  in,  192. 

Cocain,  treatment  *or  poisoning  by,  213. 

Coins,  swallowed,  treatment  for,  224. 

Colds,  germs  of,  in  infected  tonsils,  57 ; 
causes  and  treatment  of,  61-65. 

Colic,  cause  and  treatment  of,  204. 

Comminuted  fractures,  233. 

Common-sense  shoes,  25-26. 

Communicable  diseases,  132;  public  con- 
trol of,  132-133 ;  isolation  of,  133-134 ; 
disinfectants  and  methods  of  disinfec- 
tion, 134-136;  contacts,  mild  cases,  and 
healthy  carriers  of  disease  germs,  136- 
137 ;  avoiding  unnecessary  exposure, 
137;  nursing  of,  138-142;  description 
and  treatment  of  some  common,  143- 
154;  tabular  presentation  of  important 
facts  in  regard  to,  148-149. 

Complexion,  care  of  the,  7-9. 

Compound  fractures,  233,  234. 

Compresses,  hot  and  cold,  131;  for  use 
in  stopping  hemorrhage  from  wounds, 
228-229. 

Concussion  of  brain,  treatment  for,  199. 


Constipation,  causes  and  cure  of,  41-51 ; 
relation  between  colds  and,  62 ;  a  result 
of  improper  posture,  85. 

Consumption.    See  Tuberculosis. 

Convulsions,  treatment  of,  in  children, 
196-197;  in  adults,  197-198;  following 
strychnin  poisoning,  211. 

Corns,  from  ill-fitting  shoes,  25. 

Correspondence  courses  in  exercises,  un- 
satisfactory character  of,  89-90. 

Corset,  choosing  the  right,  22. 

Cosmetics,  use  of,  8. 

Counter-irritants,  128-129. 

Cramps,  cause  and  treatment  of,  204. 

Crcolin  as  a  disinfectant,  134. 

Cresol  as  a  disinfectant,  134. 

Crisis,  ending  of  fever  by,  101. 

Croup,  treatment  for,  203. 

Cuts,  methods  of  treating,  225-226. 

Cyanid  of  potassium  poisoning,  216 

Dandruff,  method  of  spreading,  9. 

Deafness,  causes  and  treatment  of,  54-55. 

Delirium  in  typhoid  cases,  169-170. 

Desks,  faulty  posture  caused  by  unsuit- 
able, 83. 

Diarrhea,  a  symptom  of  ptomain  poison- 
ing, 207. 

Diet,  for  constipation,  45-47 ;  the  ;J>- 
valid's,  182-186. 

Digitalis,  treatment  for  poisoning  by,  213- 
214. 

Digitalis  poultices,  129. 

Dilution  of  medicines,  care  in,  190-191. 

Diphtheria,  germs  of,  in  infected  tonsils, 
57  ;  treatment  of,  146-147. 

Disease  carriers,  136-137. 

Disinfectants  for  communicable  diseases, 

I34-I35- 
Disinfection,    of   rooms,    135-136;  during 

course  of  disease,  139-140;  of  excreta, 

140-141. 

Dislocations,  treatment  of,  232. 
Doctor's  orders,  importance  of  following, 

95- 

Dog  bite,  treatment  for,  222. 
Douches  and  their  use,  126-128. 
Draw  sheets,  use  of,  106-107. 
"Drop,"  the,  168. 
Drowning,    restoration    of    those    rescued 

from,  200-205. 


Index 


253 


Ear,  anatomy  and  diseases  of  the,  52-56; 
douching  the,  127;  troubles  of  the, 
following  measles,  143 ;  removal  of 
foreign  body  from,  223-224. 

Earache,  danger  of  neglect  of,  55. 

Eating,  regularity  in,  a  remedy  for  fatigue, 
20-30. 

Efficiency,  posture  and,  81. 

Electric  shock,  treatment  for,  221. 

Emergencies,  methods  of  meeting,  194-207. 

Emetics,  use  of,  for  poisoning,  208-209 ; 
when  not  to  use,  209. 

Enemas,  a  cause  of  constipation,  43 ;  hot- 
water,  to  be  used  under  direction  of 
physician,  48 ;  purposes  for  which  given, 
121 ;  methods  of  giving,  121-124;  for 
colic  or  cramps,  204. 

Epileptic  fits,  treatment  of,  197. 

Etiquette  of  the  sick  room,  96-97. 

Excreta,  disinfecting,  140-141 ;  care  of, 
in  typhoid  cases,  168. 

Exercise,  use  of  judgment  in  taking,  when 
fatigued,  29;  care  in,  during  menstrual 
period,  36 ;  special,  for  constipation,  47  ; 
distinction  between  exercises  and,  88; 
necessity  for  taking  daily,  88. 

Exercises,  purpose  and  use  of,  88,  89-90. 

Eye,  structure  and  care  of  the,  66-72 ; 
douching  the,  128;  troubles  of  the, 
following  measles,  143;  removal  of 
foreign  body  from,  223. 

Eyestrain,  avoidance  of,  68-70. 

Face,  care  of  skin  of  the,  7-9. 

Face  lotions,  use  of,  8. 

Face  masks  for  nurses,  141. 

Fainting,  causes  and  treatment  of,  194-195. 

Fatigue,  cause,  symptoms,  and  prevention 
of,  27-32 ;  relation  between  colds  and, 
62 ;  caused  by  improper  posture,  83-84. 

Feet,  bathing  the,  7  ;  care  of  the,  22-26; 
troubles  with  and  incorrect  use  of,  as- 
sociated with  faulty  posture,  85-87. 

Fever,  temperature  in,  100-101 ;  end  of, 
101 ;  giving  sponge  bath  to  reduce,  119- 
120. 

Fire,  rescuing  from,  220-221. 

Fireplace  in  sick  room,  91-92. 

Flannels,  wearing  of,  20-21. 

Flat  foot,  causes  and  treatment  of,  86. 

Flaxseed  poultices,  129. 


Fly  paper,  poisoning  by,  216. 

Food,  regularity  in  giving,  95-96;  for 
consumptives,  159;  for  typhoid  patients, 
171 ;  preparation  and  serving  of,  for  the 
invalid,  182-186;  for  the  nurse,  248. 

Food  poisoning,  treatment  for,  206-207. 

Foreign  bodies,  in  eyes,  7 1 ;  removal  of, 
from  eye,  ear,  nose,  and  throat,  223-224. 

Formalin  as  a  disinfectant,  134. 

Fractures,  treatment  of,  233-234. 

Freezing,  treatment  for,  221. 

Fresh  air,  importance  of,  31-32 ;  a  remedy 
for  colds,  61,  63;  for  pneumonia  cases, 
174. 

Gas  poisoning,  treatment  for,  199. 

German  measles,  144. 

Germs,  in  infected  tonsils,  57 ;  of  tuber- 
culosis, 136-137.  See  Bacteria. 

Glasses,  fitting  of,  70-71. 

Greenstick  fractures,  233. 

Group  exercises,  difficulty  of  correcting 
defects  by,  89. 

Gum  boils,  cause  and  effects  of,  18-19. 

Hair,  care  of  the,  9. 

Hands,  bathing  the,  9. 

Hardening  of  the  arteries,  177-178. 

Headache,  chronic,  from  neglect  of  feet,  22. 

Heart  disease,  traceable  to  pyorrhea,  18; 

a  complication  of  rheumatic  fever,  178; 

caused  by  bacteria,  181. 
Heat  exhaustion,  treatment  for,  198. 
Hemorrhage,  of  bowels  in  typhoid  cases, 

96, 1 68,  169 ;  of  the  lungs  in  tuberculosis, 

159-161;  from   wounds,    227-228;  how 

to  stop,  228. 

Hemorrhoids,  caused  by  constipation,  43-44. 
Hiccoughs,  cause  and  treatment,  205. 
Home  nursing,  general,  91-98. 
Hospitals  for  tuberculosis  patients,   162- 

163. 
Hot-water  bag,  use  of,  as  a  counter-irritant, 

128-129. 

Hydragogues,  49. 
Hydrocyanic  acid  poisoning,  216. 
Hydrophobia,  treatment  for,  222-223. 
Hygiene,  teaching  of,  to  the  young,  2. 
Hyoscyamus,  treatment  for  poisoning  by, 

214. 
Hysteria,  treatment  of,  195-196. 


254 


Index 


Impacted  fractures,  233. 

Indigestion,  colds  traceable  to,  62 ;  caused 
by  improper  posture,  85. 

Infantile  paralysis,  description  and  treat- 
ment of,  150-154. 

Infection,  channels  of,  132. 

Inflammation  of  eyelids,  70. 

Influenza,  germs  of,  in  infected  tonsils,  57. 

Inhalation,  giving  medicines  by,  187. 

Injuries,  treatment  of  common,  217-224. 

Inoculation  in  typhoid  fever,  171-172. 

Insect  stings,  treatment  for,  224. 

Insomnia,  a  symptom  of  fatigue,  28; 
taking,  medicine  for,  ig3. 

Interest  in  one's  work,  importance  of,  30. 

Internal  hemorrhage,  228. 

Inunction,  giving  medicines  by,  187. 

lodin,  treatment  for  poisoning  by,  214. 

Ipecac,  sirup  of,  for  croup,  203. 

Irish-moss  blancmange,  186. 

Irons,  rules  for  giving,  as  medicine,  190. 

Irrigation  of  bowels,  124-126. 

Isolation,  of  communicable  diseases,  133- 
134;  how  to  make  effective,  138-139. 

Kidneys,     uremic     convulsions     due     to 

diseased,  197-198. 
Koch,  Robert,  discoverer  of  tuberculosis 

germ,  155. 

Lacerated  wounds,  treatment  of,  227. 
Laxatives,  medicines  called,  4Q;    time  of 

giving,  1 88. 
Lazear,  Dr.  Jesse,  i. 
Lead  poisoning,  treatment  for,  214. 
Lightning  shock,  treatment  for,  221. 
Light  treatment  for  tuberculosis,  158. 
Liquid  diet,  foods  included  in,  185. 
Listerin  as  a  disinfectant,  135. 
Live  wires,  rescuing  from,  221. 
Lockjaw,  cause  of,  and  treatment,  226-227. 
Lysis,  ending  of  fever  by,  101. 
Lysol,  as  a  disinfectant,  134. 

Masks  for  use  in  nursing  communicable 

respiratory  diseases,  141-142. 
Massage  for  constipation,  47. 
Mattress,  changing  the,  112. 
Measles,    description    and    treatment    of, 

143-144. 
Medicinal  enemas,  124. 


Medicines,  use  of,  during  menstrual  period, 
37-38;  regularity  in  giving,  95-96; 
methods  of  administering,  187-188; 
time  of  giving,  188;  rules  for  giving  and 
taking,  188-192;  evils  of  patent,  192; 
taking  for  insomnia,  193. 

Menopause,  the,  38-40. 

Menses,  hygiene  of  the,  33-40. 

Mental  depression,  a  symptom  of  fatigue, 
28. 

Mouth,  care  of  the,  10-19. 

Mumps,  description  and  treatment  of,  144. 

Muscles  of  the  human  body,  77-78 ;  treat- 
ment of  paralyzed,  after  poliomyelitis, 

I53-I54- 
Mushroom  poisoning,  treatment  for,  214- 

215- 

Mustard  bath  for  convulsions,  197. 
Mustard  plasters,  use  of,  129-130. 

Nails,  care  of  the,  9. 

Nasal  douches,  126-127. 

Nephritis,   as  a  result  of  pyorrhea,   18; 

following  chicken  pox,  147. 
Neuritis,  caused  by  faulty  use  of  the  body, 

85- 

New  York  State,  regulations  in,  for  con- 
trol of  poliomyelitis,  151-152. 

Nightgown,  changing  the,  in. 

Nose,  anatomy  of  the,  50-60;  abnormal 
growths  in  the,  60;  caution  against 
blowing,  in  case  of  cold,  64;  douching 
the,  126-127;  removal  of  foreign  body 
from,  224. 

Nosebleed,  treatment  for,  223. 

Nurse,  training  and  duties  of  the,  240-244 ; 
duties  of  family  to,  244-245 ;  recrea- 
tion and  rest  for,  246-247  ;  bed  for,  247- 
248 ;  meals  for,  248-249. 

Nutrient  enema,  the,  123-124. 

Open-air  sleeping  for  tuberculosis,  158. 
Opium,  preparations  of,  and  treatment  for 

poisoning  by,  209-210. 
Oral  hygiene,  10-19. 
Outdoor  sleeping,  31,  158. 
Oxalic  acid  poisoning,  treatment  for,  215. 

Pain,  caused  by  improper  posture,  85. 
Paraffin,  treating  burns  with,  218-220. 
Paralyzed  muscles,  treatment  of,  153-154. 


Index 


255 


Pasteur  treatment  for  rabies,  223. 

Patent  medicines,  evils  of,  192. 

Phenacetin,  danger  in,  192. 

Phosphorus,  preparations  of,  and  treat- 
ment for  poisoning  by,  211-212. 

Piles,  caused  by  constipation,  43-44. 

Pillows,  arranging,  114. 

Pins,  swallowed,  treatment  for,  224. 

Pneumonia,  germs  of,  in  infected  tonsils, 
57 ;  ending  of  fever  by  crisis  in,  101 ; 
poultices  sometimes  used  in,  129;  de- 
scription and  treatment  of,  173-175; 
treatment  of,  with  serum,  175. 

Poisoning,  emergency  measures  in  cases 
of,  199,  208—216. 

Poisons,  precautions  regarding,  188-189. 

Poliomyelitis,  description  and  treatment 
of,  150-154. 

Polyps  in  the  nose,  60. 

Posture,  relation  of,  to  health  and  effi- 
ciency, 73-87. 

Potash,  preparations  of,  and  treatment  for 
poisoning  by,  215-216. 

Poultices,  preparation  and  use  of,  120-130. 

Prussic  acid,  treatment  for  poisoning  by, 
216. 

Ptomain  poisoning,  treatment  for,  206-207. 

Pulled  bread,  preparation  of,  186. 

Pulse,  taking  the,  102-103;  relation  of 
temperature,  respiration,  and,  103. 

Punctuality  in  serving  meals,  182. 

Punctured  wounds,  treatment  of,  226-227. 

Purgatives,  medicines  called,  49. 
I/  Pyorrhea,  16-18. 

Rabies,  treatment  for,  222-223. 
Radiographs,    of    teeth,    15-17;    of  feet, 

23-24;    of  intestines,  42;  of  tubercular 

infection,  160,  161. 
Records,  keeping  of,  93-95. 
Recreation  and   rest  for  the  nurse,   246- 

247. 

Reed,  Dr.  Walter,  1-2. 
Registration  of  nurses,  241-242. 
Removal  of  foreign  bodies,  223-224. 
Respiration,   counting  the,    103 ;    relation 

of  temperature,  pulse,  and,  103 ;  methods 

of  giving  artificial,  200-206. 
Rest,  securing  requisite  amount  of,  30-31 ; 

importance  of,  for  consumptives,  159. 
Retention  of  urine,  206. 


Rheumatic  fever,  resulting  from  pyorrhea, 

18;  acute,  178-179. 
Rheumatism,    description   and   treatment 

of,  178-179. 

Rheumatoid  arthritis,  179-181. 
Rigg's  disease,  16-18. 
Rubber  sheets,  use  of,  106. 
Rubbers,  wearing  of,  22. 

St.  Vitus's  dance,  caused  by  bacteria,  181. 

See  Chorea. 
Saltpeter  poisoning,   treatment  for,    215- 

216. 

Salt  rubs,  methods  of  giving,  1 20. 
Salt  solution,  normal,  for  use  in  colds,  62 ; 

in  simple  enema,  121. 
Scarlet  fever,   description   and  treatment 

of,  145-146. 
Schfiier   method   of   artificial   respiration, 

201,  202. 

Schools  for  nurses,  240-241. 
Semi-liquid  diet,  foods  included  in,  185. 
Serum,  use  of,  for  infantile  paralysis,  153 ; 

for  treatment  of  pneumonia,  175. 
Sheets,  rubber  and  draw,  106-107 ;  chang- 
ing, with  patient  in  bed,  107-110. 
Shock,  condition  of,  and  treatment,  196. 
Shoes,  selection  of,   22-26;  avoidance  of 

wet,  during  menstrual  period,  37. 
Sick  room,  choice  of,  and  furnishings,  91- 

93;  care  of,  96;  cheerfulness  in,  97-98; 

preparation  of,  in  case  of  communicable 

disease,     139;    for    typhoid    fever    and 

pneumonia  patients,  165. 
Simple  fractures,  233. 
Sinuses  of  bones  of  the  face,  60. 
Skin,   composition  and  functions  of  the, 

4-5- 
Sleep,   securing  right  amount  of,   30-31 ; 

fresh  air  during,  31-32. 
Sleeping  porches  for  tuberculosis  patients, 

158,  163. 
Smallpox,   description  and   treatment  of, 

147-148;  vaccination  for,  148-150. 
Snake  bite,  treatment  for,  221-222. 
Soapsuds  enema,  121. 
Soft  diet,  185. 
Solid  diet,  185-186. 
Spinal  douches,  126. 
Sprains,  treatment  of,  234-235. 
Steam  inhalations  for  colds,  63-64. 


256 


Index 


Stings,  treatment  for,  224. 

Stomatitis,  one  cause  of,  n. 

Strains,  treatment  of,  235. 

Strychnin,    danger   in,    192 ;  preparations 

of,   and    treatment   for   poisoning    by, 

211. 

Stupes,  use  of,  130-131. 
Sunstroke,  symptoms  and  treatment,  198. 
Sylvester  method  of  artificial  respiration, 

201,  204. 
Syringes  for  giving  enemas,  122,  123. 

Teeth,  care  of  the,  10-19. 

Temperature,  taking  the,  99-100;  dif- 
ferences in,  in  different  parts  of  body, 
100;  variations  in,  100-101 ;  accuracy 
in  taking,  101 ;  relation  of  pulse,  res- 
piration, and,  103 ;  in  typhoid  fever, 
166;  in  pneumonia,  174. 

Tetanus,  cause  of,  and  treatment,  226-227. 

Therapeutic  baths,  118-119. 

Thermometer,  clinical,  use  of,  99-100. 

Throat,  care  of,  56-59 ;  removal  of  foreign 
bodies  from,  224. 

Thrush,  one  cause  of,  n. 

Time  of  giving  medicine,  188. 

Tonsillitis,  pyorrhea  and,  18;  a.  cause  of 
rheumatic  fever,  178. 

Tonsils,  infected  and  enlarged,  56-59. 

Tourniquets,  use  of,  229. 

Treatments,  methods  of  giving  various, 
121-131. 

Trional,  dangers  of,  192. 

Tuberculosis,  germs  of,  in  infected  tonsils, 
57 ;  may  follow  measles,  143 ;  descrip- 
tion and  treatment  of,  155-164. 

Tumor,  occurrence  of,  during  menopause, 
39-40. 

Turpentine  stupes,  130. 


Typhoid  fever,  ending  of  fever  by  lysis  in, 
101 ;  description  and  treatment  of,  165- 
171;  vaccination  for,  171-172. 

Ulcers,  caused  by  pyorrhea,  18. 
Unconsciousness,  treatment  for,  194. 
Underwear,  choice  of,  20-21. 
Uremic    poisoning,    convulsions    due    to, 

197-198. 
Urine,  retention  of,  206. 

Vaccination,    against    smallpox,    148-150; 

for  typhoid  fever,  171-172;  for  arthritis 

deformans,  180. 
Vaginal  douches,  126. 
Venous  wounds,  227. 
Ventilation,  of  sleeping  rooms,  31-32;  of 

workrooms,   32 ;  fireplaces  as  a  means 

of,  92.    See  Fresh  air. 
Veronal,  danger  in,  192. 
Vertebrae,  the,  74-77. 
Visits  from  family  to  patient,  249. 
Vomiting,  treatment  for,  204-205. 

Whisky,  of  no  benefit  in  case  of  snake  bite, 
221. 

Whooping  cough,  description  and  treat- 
ment of,  144-145. 

"Wild  hairs"  in  the  eyes,  70. 

Wood  alcohol,  treatment  for  poisoning  by, 
216. 

Work,  importance  of  interest  in,  30. 

Worry,  a  symptom  of  fatigue,  28. 

Wounds,  methods  of  treating,  225-229; 
Carrel-Dakin  method  of  treating  in- 
fected, 220-231. 

X-ray  pictures  of  tubercular  infection, 
TOO,  161.  See  Radiographs. 


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